NURS 5334/ NURS5334 Final Exam – Advanced Pharmacology Review | UTA (Latest 2026/ 2027 Update) 600+ Verified Questions & Answers | Grade A

NURS 5334/ NURS5334 Final Exam – Advanced Pharmacology Review | UTA (Latest 2026/ 2027 Update) 600+ Verified Questions & Answers | Grade A 2026/2027 | GRADED A+ | 100% VERIFIED Question: Drugs combined with Hydrocodone Answer Aspirin, Acetaminophen, Ibuprofen Question: Benzodiazepines and CNS depressants with acetaminophen-hydrocodone Answer False, this could lead to respiratory depression Question: Buprenorphine for maintenance after opioid abuse Answer Partial opioid agonist that activated opioid receptors but produces less degree of euphoria and physical dependence compared to a full agonist Question: Naltrexone for maintenance after opioid abuse Answer Naltrexone is a opioid antagonist that blocks the euphoric and sedative effects of opioids. Question: Side effects of Hydrocodone Answer Constipation, Respiratory depression, Addiction Question: MOA of Sumatriptan Answer Selective agonist for serotonin 5HT receptors on intracranial blood vessels and sensory nerves of the trigeminal system, causes VASOCONSTRICTION and reduces neurogenic inflammation Question: Feverfew use Answer Migraine Prophylaxis Question: Drugs that cannot be combined with Feverfew Answer Antiplatlets, Anticoagulants, Increased risk of bleeding in patients taking antiplatelets (Aspirin) and anticoagulants (Warfarin) Question: Folic acid for Folic Acid Deficiency Answer Give 1-2mg/day PO for a deficiency Question: Folic acid for women of childbearing age Answer 400-800 mcg daily Question: Folic acid for pregnant women Answer 400-600 mcg/day Question: Tacrolimus and Pimecrolimus cream use Answer Atopic Dermatitis (Eczema) Question: Safe drug classes in later pregnancy Answer Beta blockers Question: Safe medications for pregnant women Answer Methyldopa and Labetalol are the traditional agents of choice for pregnant women Question: Methyldopa and Labetalol use in pregnancy Answer These drugs have limited effects on uteroplacental and fetal hemodynamics and do not adversely affect the fetus or neonate Question: Anticholinergics for drooling in Parkinson's Answer True Question: Medication for COPD with eosinophils 312 Answer Salmeterol + aclidinium + Budesonide Question: COPD Group A Answer Bronchodilator Question: COPD Group B Answer LABA + LAMA Question: COPD Group E Answer LABA + LAMA Question: Body fat percentage effect on lipid soluble drugs Answer The higher the body fat percentage the more the plasma levels of lipid soluble drugs will be reduced Question: Lean mass decrease effect on water soluble drugs Answer Increased Question: Malnourished elderly patients and protein binding drugs Answer Increase Question: Proquad Vaccine education Answer Deposited getting the vaccine there is still a chance your child could get breakthrough chickenpox Question: Starting dosage of thyroid medication for 51-year-old Answer 50 mcg Question: Starting dosage of thyroid medication for 68-year-old Answer 25 mcg Question: Dosage range for thyroid medication with CAD Answer 12-25 mcg Question: Attenuated vaccine definition Answer Live Virus, but weakened Question: Immunocompromised patients and Attenuated Vaccines Answer False, live vaccines can be dangerous in recipients who are immunocompromised because these people are unable to mount an effective immune response, even against a virulent organism Question: TDap vaccine administration window for pregnant women Answer 29 - 36 weeks Question: Gardasil protection in females Answer HPV 6, 11, 16, 18, 31, 33, 45, 52, 58, Cervical Cancer, Vaginal Cancer, Vulvar Cancer, Genital Warts Question: Gardasil protection in males Answer HPV 6, 11, 16, 18, 31, 33, 45, 52, 58, Genital Warts Question: MOA of Haloperidol Answer Blocking the dopamine D2 receptors in the brain, inhibiting the dopamine receptors help reduce the symptoms of psychosis such as hallucinations Question: Adverse effects of Haloperidol Answer Extrapyramidal Side Effects Question: MOA of Chlorpromazine Answer Blocking dopamine D2 receptors in the brain Question: Extrapyramidal symptoms Answer Dystonia, Tardive dyskinesia, Akathisia, Pseudoparkinsonism Question: MOA of Second Generation antipsychotics Answer Dopamine D2 receptor antagonist and Serotonin 5-HT2A Receptor antagonist Question: Endings of Atypical Antipsychotics Answer -pine, -idone, -zole Question: Side effects of Clozapine Answer Agranulocytosis, Diabetes, Dyslipidemia, Weight Gain Medication for Tardive Dyskinesia Answer Valbenazine followed by Deutetrabenazine Foods to avoid on Levodopa/Carbidopa Answer High protein diet needs to be avoided. High protein food can delay absorption Vitamin A safety during pregnancy Answer False, Vitamin A toxicity is Teratogenic Signs of Vitamin A Toxicity Answer Liver injury, Bone related disorders Antidepressant with least sexual side effects Answer Bupropion Nonpharmacological Management of Gout Answer Low Purine diet, Joint rest, Weight Reduction, Fluid intake of 3 Liters First-line treatment for Gout Answer Allopurinol NSAIDs for Rheumatoid Arthritis Answer True DMARDs for Rheumatoid Arthritis Answer True First-line treatment for Moderate to Severe Rheumatoid Arthritis Answer Methotrexate Methotrexate Answer Methotrexate is first line treatment of rheumatoid arthritis for moderate to severe disease. Hydroxychloroquine Answer Hydroxychloroquine is used for Mild disease of RA. Regular Eye Exams Answer It's important to get Regular Eye Exams because plaquenil binds to retinal pigment cells and can cause retinal toxicity and destroy the macular. NSAIDS and Glucocorticoids Answer NSAIDS and Glucocorticoids can be used for management of acute flare ups for gout, True or False? True. MOA of Fibrates Answer Fibrates work by activating PPARα which are intracellular receptors that regulate fat and carbohydrate metabolism. Increase the breakdown of triglycerides into fatty acids via beta oxidation. Fibrates for triglycerides Answer Fenofibrate, Gemfibrozil, Lovaza. Effect of Fibrates on LDLs Answer Fibrates have little effect on LDLs, True or False? True. Best Statins for Hyperlipidemia Rosuvastatin, Atorvastatin. Recovery for Rickets Vitamin D. Foods for Vitamin D replacement Fortified Foods, Cereals, Milk, Yogurt, Margarine, Cheese, Orange Juice. Therapeutic use of Feverfew Migraine Prophylaxis. Drugs not mixed with Feverfew Patient has an increased risk of bleeding in patients taking Anticoagulants and Antiplatelets: Antiplatelets (Aspirin), Anticoagulants (Warfarin). Therapeutic use of Coenzyme Q-10 1. Treat Heart Failure, 2. Muscle Injury caused by HMG-CoA reductase inhibitors (Statins), 3. Mitochondrial Encephalopathies (muscle and nervous system injury). Side effect of CoQ-10 GI Disturbances. CoQ-10 interaction CoQ-10 is structurally similar to Vitamin K and can have antagonizing effects on Warfarin. Vitamin B12 deficiency side effects 1. Neurologic Damage: Numbness and tingling in the hands and feet, 2. Impaired production of white blood cells, 3. GI Disturbances: impaired absorption. Natural supplement for Osteoarthritis Glucosamine/Chondriton. Glucosamine/Chondriton and shellfish allergy False, Glucosamine/Chondriton should be used with caution with people that have a shellfish allergy. Medication to reduce prostate size Finasteride. Optimal Diabetes medication for weight loss B. Liraglutide: Liraglutide is a GLP-1 agonist that is approved for chronic weight management in adults. Therapeutic use of Buprenorphine Maintenance therapy for opioid dependence. MOA of Buprenorphine Partial mu agonist, kappa antagonist. Therapeutic use of Naltrexone Naltrexone is an opioid antagonist. This is maintenance therapy for opioid dependence and to prevent relapse. Opioid effect on Naltrexone False, if an opioid is taken while a patient is on naltrexone, it will prevent a euphoric effect. Application of Topical Glucocorticoids Topical Glucocorticoids should be applied in a thin film and gently rubbed into the skin. Dose of Terbinafine for Onychomycosis on fingernail 250 mg daily for 6-12 weeks for fingernail. Dose of Terbinafine for Onychomycosis on toenail 250 mg daily for 3-6 months for toenail. MOA of Denosumab Inhibits binding of RANKL to RANK, decrease osteoclast maturation and formation, decrease bone resorption. How Bisphosphonates work Inhibit osteoclast bone resorption. Gallium Nitrate MOA Inhibits bone resorption. Ending of Bisphosphonates - dronate. Adverse effects of Bisphosphonates Atrial Fibrillation, Atypical Femur Fractures, Esophageal Ulcers, Osteonecrosis of the Jaw, Ocular inflammation, Hyperparathyroidism, Renal Impairment. Most common disease in menopausal women Osteoporosis. First-line treatment for GERD Diet and Lifestyle modifications with an Antacid. Second step in GERD medication intervention Add H2 receptor blocker. Third step in GERD medication intervention Add a Proton Pump inhibitor. Example of H2 receptor blocker Famotidine, Cimetidine, Nizatidine Capsules, Ranitidine. Examples of Proton Pump Inhibitors Omeprazole, Esomeprazole, Rabeprazole. Pyridoxine effect on levodopa True, Pyridoxine stimulates decarboxylase activity of Pyridoxine and can decrease the amount of levodopa available to the CNS. Adverse Effects of Phenytoin Nystagmus, Sedation, Ataxia, Diplopia, Cognitive impairment, Gingival Hyperplasia. Education for patients taking Phenytoin Make sure to do thorough oral care due to Gingival Hyperplasia. Serotonin Crisis symptoms Starts 2 - 72 hrs after treatment: Altered mental status, Agitation, Confusion, Disorientation, Hallucinations, Myoclonus, Hyperflexia, Excessive sweating. Resolution of serotonin syndrome Stop the medication. Non-stimulant medications for ADHD Atomoxetine, Viloxazine. Tricyclic antidepressants for ADHD Desipramine, Imipramine. Clonidine α-2 Adrenergic Receptor Agonist used for ADHD. Guanabenz α-2 Adrenergic Receptor Agonist used for ADHD. Guanfacine α-2 Adrenergic Receptor Agonist used for ADHD. Bupropion Medication used for smoking cessation that can also be used for adult ADHD. α-1 receptors in males Trigger ejaculation. Activation of α-1 receptors and blood vessels Causes contraction. Activation of α-1 receptors and the eye Causes pupillary dilation. Activation of α-1 receptors and the bladder Increases sphincter tone. Activation of α-1 receptors and the kidney Decreases Renin release. Location of α-2 receptors Presynaptic Neurons. Effects of β-1 receptors on the heart Increase Heart Rate, Increase conduction at AV node, Increase strength of contraction. Effects of β-1 receptors on the kidney Increase Renin Release. Effects of β-2 activation Bronchial dilation, Relaxation of the Uterus, Vasodilation, Build and Burn Glucose, Glycogenolysis, Gluconeogenesis, Increase Insulin. Effects of M1 Muscarinic receptors Salivary Glands, GI Secretions, CNS. Effects of M2 receptor on the heart Decreases HR, Decreases Conduction. Effects of M3 Muscarinic receptors Eye Constriction and Accommodation, Lungs: bronchiolar contraction and secretion, Promotes digestion increase motility and relax sphincters, Increase Salivation, Promotes voiding, Increases sweating and lactation. MOA of Bethanechol Muscarinic agonist that activates the Cholinergic receptors. Therapeutic uses for Bethanechol Treatment of urinary retention, Stimulate intestinal Motility in people with Ileus. Contraindication of Bethanechol in asthma Constricts bronchi and exacerbates asthma. Use of Bethanechol post surgery To get the patient to pee and poop. Bethanechol and hyperthyroidism False, can cause dysthymias in patients with Hyperthyroidism. MOA of Atropine Blocks the ability of Ach to bind to parasympathetics, resulting in increased HR, BP, & SVR. Pharmacological effects of Atropine Increased Heart Rate, Decreased Secretions, Relaxes Bronchi, Decreases Bladder Tone, Decrease GI Tract Motility. Atropine and asthma Can worsen asthma by drying secretions. Atropine for eye exam Dilates pupils in preparation for an eye exam. Medication to combat Cholinergic effects Atropine. Side effects of Atropine Dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, and urinary retention. Recommended medications for African American with NYHA class III-IV HFrEF Hydralazine + Isosorbide Dinitrate. Patients benefiting most from diuretic therapy African Americans. Contraindications for Aloha agonist drugs Patients with severe cardiovascular conditions such as Hypertension and Cardiac Arrhythmias. MOA of Latanoprost Increases aqueous humor outflow by relaxing the ciliary muscle. Side effects of Latanoprost Brown pigmentation of iris/lids/lashes, Blurred Vision, Burning/Stinging, Conjunctival Hyperemia, Macular and Conjunctival Edema, Punctate Keratopathy. MOA of Terazosin Alpha 1 antagonist that blocks alpha 1 receptors in the bladder neck, prostate capsule, and prostatic urethra. MOA of Metformin Inhibits glucose production by the liver and decreases insulin resistance. Adverse effects of Metformin GI Disturbances, Lactic Acidosis. Metformin and insulin production False, it primarily reduces hepatic glucose production and improves insulin sensitivity. MOA of Sulfonylureas Stimulate insulin release from pancreatic beta cells. Sulfonylureas and weight gain False, they cause weight gain, not weight loss. Names of 3 Sulfonylureas Glipizide, Glyburide, Glimepiride. Sulfonylureas and blood sugar True, they stimulate insulin release from the beta cells of the pancreas. MOA of Repaglinide and Nateglinide Stimulate rapid, short term insulin secretion. Meglitinides and blood sugar Yes, they reduce blood sugar. MOA of Glitazones Increase insulin sensitivity in peripheral tissues and decrease gluconeogenesis. MOA of DPP-4 inhibitors Increase incretin levels, which inhibit glucagon release and increase insulin secretion. Sitagliptin and blood sugar True, it increases insulin production and decreases glucose production. MOA of Canagliflozin Increases urinary excretion of glucose. MOA of Semaglutide GLP-1 receptor agonist that slows digestion and glucose absorption. Sitagliptin An oral medication that reduces blood sugar and increases insulin production. Liraglutide An injection medication that reduces blood sugar and increases insulin production. Cholinergic and Myasthenia crisis Distinguished by administering edrophonium; if symptoms are alleviated, it's Myasthenic, if intensified, it's Cholinergic. Levadopa and Carbidopa combination Combined to ensure more Levadopa reaches the brain by decreasing peripheral metabolism. Levothyroxine Synthetic form of T4 converted to T3 in peripheral tissues, used for pregnant patients with Hypothyroidism. TDap vaccine timing Given to pregnant females with every pregnancy between 27th to 36th weeks. Varicella and MMR vaccine education Educate that the child can still get breakthrough chickenpox. Shingrix Vaccine eligibility Patients 50 years of age and older. Shingrix Vaccine type Recombinant Vaccine. Shingrix Vaccine administration Administered in two doses six months apart. INITIAL treatment for Asthma in Adults Symptom driven treatment with low-dose inhaled Corticosteroids and a LABA, example: Budesonide-Fomoterol. Erenumab The first monoclonal antibody approved for the prevention of Migraines. Folic deficiency treatment in Celiac Patient Cyanocobolamin (B12) with Folic acid. Fever medication for a 6 month old Acetaminophen. Hypertension medications for Pregnant women Methyldopa, Nifedipine (CCB), Labetalol (BB). Sildenafil and Nitrates consequence Hypotension. First-line treatment for poison ivy Topical Glucocorticoids. Sildenafil and Nitrates usage False, avoid Nitrates when using Sildenafil. Combining Sildenafil and Nitrates side effect Hypotension. Medication for osteoporosis in men Alendronate. Medications for BPH and HTN Doxazosin, Finasteride, Terazosin, Dutasteride. Inhaled Corticosteroids side effects Oropharyngeal Candidiasis, Dysphonia, Osteoporosis (with long-term use). ASAs and NSAIDS contraindication in asthma Can induce bronchospasm. Medication for Hyperthyroidism in pregnant women Propylthiouracil. MOA of Propylthiouracil Inhibits thyroid hormone synthesis by blocking the oxidation of iodine and the coupling of iodothyronines. Initial dose determination of thyroid hormone Based on body weight, 1.6 - 1.8 mcg/kg/day. Topical Antifungals for Tinea Capitis False, best treated with oral medication. Medication for Tinea Capitus Grisofulvin by mouth daily. Cardioselective Beta Blockers Acebutolol, Bisoprolol, Esmolol, Atenolol, Metoprolol. Non-selective beta blocker issue Can cause Hypoglycemia. Side effects of Serotonin Syndrome Hyperreflexia, Fever, Altered Mental Status, Agitation, Confusion, Disorientation, Anxiety, Hallucination, Poor concentration, Myoclonus. Fluid intake when taking iron To decrease constipation. Over the Counter Cold remedies in children True, should be avoided in children 4 - 6 years old. MOA of Scopolamine Muscarinic receptor antagonist. Therapeutic use for Scopolamine Motion sickness. Benefit of Transdermal Scopolamine Patch Anticholinergic side effects may be less intense than with oral or subcutaneous dosing. Reaction with Metronidazole and alcohol Disulfiram Reaction. Dose for Ferrous Sulfate 15 mg/kg/day in 3 to 4 doses or 325 mg 2-3 times daily. First-line treatment for Fungal Otitis Externa Acidifying Drops. Medication if Acidifying drops do not work 1% Clotrimazole. Therapeutic Use for Ginkgo Biloba Peripheral artery disease. Ginkgo Biloba and Warfarin interaction Increases risk for bleeding. Medication for Muscarinic Poisoning Atropine. Full agonist definition A drug fully capable of activating the effector system when it binds the receptor. Side effects of Tamsulosin Orthostatic hypotension, Ejaculation failure, Fainting and Dizziness, Somnolence, Nasal Congestion. Lab to check for muscle pain in Statin patients Creatinine Kinase (CK) / Creatinine Phosphokinase (CPK). Medication for triglyceride levels over 500 Fibrates. Antidepressant without sexual side effects Bupropion. Age qualification for flu shot 6 months or older. Pregnant women and flu shot Yes, they can get the flu shot. Flu shot eligibility with egg allergy No, individuals with an allergy to egg do not qualify for the flu shot. Prescribing basics Prescribing is regulated by state BON Proper RX Providers name and address, Telephone DEA Pt name/DOB/Addres Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and signature. Drug Schedules: Most addictive to least 1: Heroin,LSD, MJ 2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl, adderall, ritalin 3: codeine, ketamine, testosterone 4: xanax, valium, soma, ambient, tramadol 5: antidiarrheal, antitussives, lomotil, lyrica Pharmicodyamics The effects of drug on the body. Receptors are large molecules usually proteins, that interact and mediate the action of drugs agonist produce receptor stimulation and a conformational change every time they bind. Do not need all available receptors to produce a maximum response Partial agonist drugs that have properties in b/w those of full agonist and antagonist. They bind to receptors but when they occupy the receptor sites, they stimulate only some of the receptors. antagonist drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation. The block action of drugs (ex. Narcan) Bioavailabity % of administered dosage of the drug that survives the first pass through the liver and reaches the blood stream half life Time required for the amount of a drug in the body to decline by 50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the body what the body does to the drug absorption, distribution, metabolism, excretion Distribution movement of absorbed drug in bodily fluids throughout the body to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse) Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs can pass) Protein binding unbound drug is free which is active, crosses membrane. Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugs Metabolism take place in the liver mostly. Chemical change of a drug structure to: Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive until metabolized in the body into the active compound, ex: levodopa), increase or decrease toxicity CYP450 enzymes constitutes the most important of the phase I metabolizing enzymes (account for about 75% of drug metabolism in the liver) Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates rendering them more readily excretable Substrate an agent that is metabolized by an enzyme into a metabolite and product and eventually excreted Inhibitors compete with other drugs for a particular enzyme affecting the metabolism (decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating drug inducer competes with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drug excretion renal: passive glomerular filtration, active tubular secretion, tubular reabsorption, gi tract, lung, sweat and salivary, mammary genomics study of the complete set of genetic information present in a cell, an organism, or species pharmacogenetics the study of the influence of hereditary factors on the response of individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug response Pharmacogenetics tests Mentioned on drug labels can be classified as "test required," "test recommended," and "information only." Currently, four drugs are required to have pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab, maraviroc and dasatinib wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial dosing Carbamazepine and Asisans Initiating carbamazepine therapy in these patients (allele HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis (TEN) The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What are they? Molecular size, Lipid solubility, degree of ionization at tissue pH Why is epinephrine given with local anesthetics? Decreases local blood flow (decreased risk of bleeding) Delays systemic absorption of the anesthetic prolongs anesthesia reduces the risk of toxicity What is the most widely used local anesthetic? Lidocaine What is a possible fatal reaction to benzocaine Methemoglobinemia What is included in application guidelines for topical anesthetics avoid wrapping the site and heating the site, avoid application to open skin Which medication will not cause rebound headaches from overuse? propranolol (preventative) What is the best option for menstural migraine? low dose estrogen about 3 days prior to menses What food can trigger migraines? Hot dog d/t nitrates What medication is a Seratonin 1B1D receptor agonist? Sumatriptan Butterbur can help as prevention for migraine therapy. What side effect can occur? Liver damage What are the 3 main classes of opiod receptors? Mu kappa delta Which of the following will reserve he effects caused by opioid agonist? naloxone Which of the medications are used to treat OIC? Naloxegol, methylinaltrexone, lubiprostone Tolerance is defined as increased does of a med needed to obtain the same response Which medication is used for opioid abuse? Naltrexone Euphoria induced by morphine: An exaggerated sense of well-being caused by the activation of mu receptors Which medication is given nasally for migraines? Butorphanol Which of the following describes the mechanism of NSAIDs? Inhibition of the cyclo-oxygenase enzyme Second generation COX 2 inhibitors: Suppress inflammation and cause less risk for gastric ulceration than COX 1, increase risk for heart disease Which of the following medications should not be given with ASA? Glucocorticoids Which medication is given for acetaminophen overdose? Acetylcysteine What are non endocrine therapeutic uses for glucocorticoids? RA, SLE, IBS, Bursitis, OA, Gout, disorders of the eye What is the danger of prolonged use of glucocorticoids? adrenal insufficiency Methotrexate can cause fatal toxicities of: Bone marrow, liver, kidneys, lungs. Hemorrhagic enteritis and GI perforation Jane is on etanercept for RA. The NP knows Jane should be checked for TB yearly What is first line treatment for gout? Colchicine, indomethacin When would you initiate a Uriosuric Medication? more than 3 gout attacks per year Antiinflammatories inhibition of COX 1: protects against MI and stroke inhibition COX 2: surpasses inflammation, pain and protects against colorectal cancer (less GI bleeding) first generation NSAIDS inhibit COX 1 and COX2: treatment is for relief of mild to moderate pain, relief of cramps r/t dysmenorrhea (risk GI bleed and renal impairment) generation 2 NSAIDS only suppresses COX2, decreased risk for GI bleeding but impose risk for increased heart disease Aspirin Non-selective inhibitor of COX, therapeutic use analgesic, fever, mensural cramps, anti-inflammatory, Alzheimer disease. Risk for bleeding is too high. Increased secretion of acid and pepsin therefore ruins all the protective lining of the stomaching. Pt at risk: alcoholics, smoking, older people, or people who have had PUD. Risk of ASA is not advised in pt younger than 18 r/t Reyes syndrome, pregnancy because it cause ductus arteriosis, if given with Ibuprofen it can decrease effects of ASA. first generation non-ASA NSAIDS inhibit COX 1 and 2, given for RA and OA, no protection against MI or stroke. ex. Ibuprofen, alieve, diclophinac. Indicated for mild to moderate pain, antiinflammaroty and analgesic effects. risk of GI bleed Celebrex second generation non ASA nsaids, lower risk for GI but can still cause renal impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies. Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors. Acetaminophen Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr period. for overdose: acetylesistine. Can blunt immune response of vaccines glucocosteroids Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7 days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants. Therapeutic use: allergic condition, asthma and immune suppression. RA very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases. * First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline) Gout Monoarticular arthritis, d/o r/t kidney don't excrete enough uric acid. Only way to diagnosis is joint aspiration and look for the uric crystals Prevention is best Gout preventions Migraines trial and error of medication and triggers. start with over the counter and move to more aggressive over time. +2 a month, preventative medication is okay. Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasm Preventative: Beta blockers, antiseizure medications (depikote and topimax), tricyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur. cluster headaches intensely painful headaches that affect one side of the head and may be associated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutes prophylaxis tx with regular Headaches Depression tx SSRI, SNRI, Bupropion are first line treatments. Least side effects of any medications Mild/moderate depression or anxiety are okay to treat but anything else needs to be referred to a psychiatric NP tricyclic antidepressants Weigh gain, drowsiness, and terrible anticholinergic effects. beers list, Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. SSRIs Fluoxetine, paroxetine, sertraline, citalopram. effects don't start for several weeks (4-6 weeks) can cause weight gain, vivid dreams, bruxism, bleeding disorders, ED/sexual dysfunction, hyponatriemia, most can cause n/v that might go away. need to taper off these meds. can be used for panic disorder, pms, anxiety, ptsd, post menopausal women SNRI serotonin norepinephrine reuptake inhibitors, opposite of SSRI (weight loss and increase in energy) Desvenlafaxine (Pristiq, Khedezla) Duloxetine (Cymbalta) ― also approved to treat anxiety and certain types of chronic pain Venlafaxine (Effexor XR) ― also approved to treat anxiety and panic disorder S/E:Nausea Dry mouth Dizziness Headache Excessive sweating Other possible side effects may include: Tiredness Constipation Insomnia Changes in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction) Loss of appetite Brupropion (wellbutrin) stimulate, appetite suppressant, helps with sexual side effects of SSRIs, S/E: dry mouth, constipation and increase risk of seizure disorder St. John's Wart (Hypericum perforatum) don't want to give this to patients with SSRIs, a lot of drug reactions, dosed at 300mg TID, CYP450 inducer lithium Excretion is reduced with sodium levels are low. S/E: GI disturbances, n/v/d, ataxia, thirst, tremor, high urine output, death. Very narrow therapeutic index Benzodiazepines drugs that lower anxiety and reduce stress: alprazolam, diazepam alcohol abuse nicotine abuse Prior to starting antidepressants, patients should have what lab testing to rule out hypothyroidism A 32 yo male is starting paroxetine for depression. He is complaining of not being able to obtain an erection. What can the NP do to help? add bupropion A 6 yo us being treated with ethosuximide. She should be monitored for: Blood dycrasias which are uncommon but possible. Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with lamotrigine and cause: reduced lamotrigine levels, requiring an increase in the dose of lamotrigine The tricyclic antidepressants should be prescribed cautiously in patients with CAD Atropine Cause pupil finalization in eye exam Bethanechol (Urecholine) GI/GU stimulation following surgery, parasympathomimetic Pyridostigmine (Mestinon) Category: Cholinergic, Anticholeristinase, Use: Myasthenia Gravis, Precautions: May cause cram,ps, increased peristalsis Doxazosin (Cardura) Hypertension, BPH Albuterol Asthma inhaler Scopolamine (Transderm Scop) Anticholinergic (drying effects) Used for motion sickness Can cause sedation, anticholinergic effects Phenylephrine Sudafed PE; sympathomimetics Propranolol (Inderal) Beta adrenergic blocker for hypertension Dobutamine (Dobutrex) sympathomimetic Indication: short term management of heart failure Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Nursing Considerations: - Monitor hemodynamics: hypertension, ↑HR, PVCs - Skin reactions may occur with hypersensitivity - Beta blockers may negate therapeutic effects of dobutamine - Monitor cardiac output - Monitor peripheral pulses before, during, and after therapy - DO NOT confuse dobutamine with dopamine Acetylcholine binds to both _____ and ______ receptors nicotinic and Muscarinic Norepinephrine binds to both ____ and ____ receptors alpha and beta Atropine is considered to be the antidote to ______ toxicity Cholinergic Sympathomimetic is the same as _______ agonist adrenergic Sympatholytic means the same as Anti-_____ adrenegic Muscarinic antagonist means the same as anti-_____ cholinergic cholinergic means the same as _____ agonist and parasympathetic_____ muscarinic and mimetic Bradycardia, urinary urgency, bronchoconstriction, and pupillary constriction are the signs of _______ toxicity cholinergic Pupillary dilation, tachycardia, urinary retention and dry mouth are signs of muscarinic _________ drugs such as atropine antagonist An anticholinergic drug will _______ acetylcholine availability to the tissue? increase Alpha 1 agonist______ BP, while alpha 1 antagonists ________ BP? increase, decrease beta 1 receptor activation will lead to _____ heart rate? Beta 1 blockade will _____ Heart rate? increases/decrease beta 2 receptor activation will lead to _______ however, administering a non-cardioselective beta blocker can lead to _____? bronchodialiation/bronchoconstriction Alpha 2 agonist such as clonidine will _____ BP? lower A ______ inotrope will increase contractility; a ______ chronotrope will decrease HR; while a _______ dromotrope will decrease conduction via the AV node? positive, negative, negative Epinephrine is used in many emergency situations, such _______, Cardiac______ and hypo_______ anaphylaxis, cardia arrest, hypotension what "onset of actions symptoms" should be reviewed with patients who have been newly prescribed an SSRI? they can feel a bit of nausea but this resolves in about 1 week Jaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI. What is the initial dosage adjustment when starting to taper off antidepressants? reduce the dose by 50% for 3-4 days One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: GI problems, drowsiness and nausea, seizures and coma are serious problems. monitoring of a patient on gabapentin to treat seizures includes: Recording seizure frequency, duration and severity Sam, aged 65, is started on L-dopa for his Parkinson's disease (PD). He asks why this is necessary. You tell him: the primary goal of therapy is to replace depleted stores of dopamine A 55yo patient develops parkinson's disease characterized by unilateral tremors only. The NP will refer the patient to a neurologist and should expect initial treatment to be Ropinirole (lesser symptoms need lighter drug) Inattention and sleep-wake cycle disturbance are hallmark symptoms of: delirium 3 types of information needed for neuropharmacologic drugs: type or types of receptors through which the drug acts. Normal response to the activation of those receptors (Agonist vs antagonist) What the drug in question does to receptor function cholinergic receptors and adrenergic receptors are mediated each by? Cholinergic by acetylcholine and adrenergic by epinephrine and norepinephrine what are the subtypes of cholinergic and adrenergic receptors? cholinergic: nicotinic and mu Adrenergic: Alpha1, alpha2, beta1, beta 2 and dopamine what are the functions of alpha1 receptors? Vasoconstriction, ejaculation and contraction of bladder neck and prostate what are the functions of alpha 2 receptors? minimal clinical significance what are the functions of Beta 1 receptors? Heart: increases heart rate, force of contraction, velocity of conduction in AV node. Kidney: renin release what are the functions of beta 2 receptors? Bronchial dilation relaxation of uterine muscle vasodilation glycogenolysis what are the functions of Dopamine receptors? dilates renal blood vessels what are the functions of cholinergic drug receptors? Blocks the action of acetylcholine. Cholinesterase inhibitors prevent the breakdown of acetylcholine Examples of anticholinergic drugs bethanechol, atropine, oxybutynin, scopolamine, ipratropium bromide They turn everything off and dry everything Side effects of anticholinergics dry mouth, blurred vision, constipation, photophobia, urinary retention "I can't see, can't pee, can't spit, can't shit" understand alzheimer's medications understand parkinsons medications Know psychiatric drugs (1st and 2nd line) for: depression anxiety bipolar OCD Sterling's Law of the Heart the more the cardiac muscle is stretched, the stronger the contraction Calcium Channel Blockers agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension s/e: constipation, lower extremity edema, increased risk of heart block and gingival hyperplasia Know the stages of hypertension/heart failure bond williams classification Renin Inhibitors Aliskiren (Tekturna) binds tightly with renin and inhibits the cleavage catalyzes the conversion of angiotensin i (inactive) to angiotensin II (highly active) ACE inhibitors contstricts renal blood vessels acts on the Kidney to promote retention of sodium and water and excretion of potassium "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension ARBS block access of angiotensin II cause dilation of arterioles and veins Prevent angiotensin II from inducing pathologic changes in cardiac structure Reduce excretion of potassium Decrease release of aldosterone Increase Renal excretion of sodium and water DO not inhibit Kinase II do not increase levels of bradykinin Aldosterone Antagonists selective blockade of aldosterone receptors in the kidney promotes excretion of sodium and water and thereby reduces blood volume (spiralonlatome) Calcium Channel Blockers do what to the heart have exact same effect on heart as beta blockers. They suppress calcium influx and reduce force of contraction and slow heart rate and suppress conduction through the AV node what are common side effects of CCBS are: constipation, LE edema, gingival hyperplasia what are the therapeutic uses for nifedipine? Migraines, angina, HTN beta blockers _____ the adverse cardiac effects of nifedipine but can ____ the adverse cardiac effects of verapamil and diltiazem decrease; intensify john is taking hydralazine for elevated BP. He comes in with arthralgia. What blood test might be elevated? ANA Untreated HTN can lead to what? angina, CHF, MI, kidney disease, stroke SYMPHATHOLYTICS are antiadrenergic drugs how is stage A CHF managed? Manage risks only true or false: virtually all dysrhythmias can also cause dysrhythmias TRUE Which medication is used to treat digoxin induced dysrhythmias? Phenytoin bill is taking amiodarone for his atrial fibrillation. What diagnostics will need to be done? TSH and chest x ray every 6 months recommended cholesterol screening is: every 5 years after 20 Lucy is taking gemfibrozil and warfarin. You know how to check INR and expect that INR might be Elevated (gemfibrozil displaces warfarin from plasma protein) Bill has prinzmetal's angina and it is wakening him at night. What will the NP prescribe? CCB How do you prevent nitrate intolerance? Give smallest possible dose and have 8 free hours per day with long acting nitrates Mary has been admitted with unstable angina. You know she will be treated with? ASA Plavix Beta blocker Statin ACE What happens when clopidogrel is given with a PPI? the anti platelet effect is decreased What role does O2 play in STEMI? Although oxygen is recommended and using it seems to make sense, the practice is not evidence based What role does ASA play in STEMI? ASA caused a substantial reduction in mortality What role does morphine play in STEMI? in addition to relieving pain, morphine can improve hemodynamics by promoting ventilation, the drug reduces cardiac preload What role does Nitro play in STEMI? 1. reduce preload and thereby reduce oxygen demand 2. increase collateral blood flow in the ischemic region of the heart 3. control hypertension caused by stemi-associated anxiety 4. limit infract size and improve LV function however, despite these useful effects, nitroglycerin does not reduce mortality What role does BB play in STEMI? decreases myocardial oxygen demand; reduce cardiac pain, infract size, and short term mortality; recurrent ischemia and reinfarction are also decreased Which must heparin bind to in order to exert its anticoagulant effects? Antithrombin III- heparin binds to antithrombin III then inactivates thrombin and factor Xa Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? cholestyramine A 58 yo female reports that she recently stopped taking her blood pressure meds because of swelling in her feet that began shortly after she started treatment. Which of the following is most likely to cause peripheral edema? Felodipine (CCB) Jack is taking Colesevelam. The NP tells him to: He needs to increase fluid and fiber A 54 yo male is noted to have hyperlipidemia, and is prescribed atorvastatin. This drug reduces plasma cholesterol by which processes? Inhibiting cholesterol biosynthesis A 42 yo woman is noted to have type 2 Diabetes. She has HTN with BP 150/94. The UA shows mild albuminuria. Which of the following drugs would be the best choice to treat HTN? Enalapril Brad has HTN and is found to have enlarged prostate on exam. His BP has been running in the 150/90 range. Which of the following meds would offer treatment for both? terazosin Which best describes the action of ACE inhibitors on the failing heart? Reduces preload Which of the following is the most accurate statement regarding digoxin? Increases vagal tone and decreases AV node conduction Which of the following is a limiting adverse effect of ACE inhibitors? hyperkalemia Which of the following medications can be used to treat gestational diabetes? Metformin and insulin What is the 4 step approach in the treatment of DM type 2? Step 1: lifestyle +metformin step 2: continue step 1 and add second drug step 3: step up to 3 drugs (including metformin) step 4: more complex insulin regimen John comes in with random glucose of 250? Does he need any further testing? NO Jane has type 1 diabetes and is taking a beta blocker. what does she need to be aware of? Beta blockers impair glycogenolysis and glycogenolysis is a means which the body can respond to and counteract a fall in blood glucose Gina is taking canagliflozin for her diabetes. The NP tells her this may increase her risk for? UTIs SGLT-2 inhibitors cannot be given if GFR 35. t or f? FALSE: can be given with GFR less than 35 opitmally at what interval should the TSH be reassessed after a levothyroxine dosage is adjusted? 6-8 weeks which of the following can induce thyroid dysfunction? Amiodarone Irma is an 80 yo with CAD. She has an elevated TSH with a low free T4. She weighs 80kg. What dosage of levothyroxine are you going to initiate? 12.5-25 mcg Stacy is 30 yo that has elevated TSH and low free T4. She weight is 100lbs. What does of levothyroxine will you give her? 75 mcg Jane is in her first trimester of pregnancy and has symptomatic hyperthyroidism. What is the endocrinologist going to prescribe? Propylthiouracil Mary is postmenopausal is having severe vasomotor symptoms. She has a uterus. She would like to start on hormones. The NP Will start her on estrogen and progesterone Julie is wanting to start OCPs but would like to discontinue in 1 year to try for pregnancy. The NP will prescribe: Beyaz due to having added folic acid A patient just call you and she missed a pill. She is on a 28 day cycle. you tell her: take the pill as soon as possible and continue the pack. Use another form of contraception for 7 days Lisa has migraines with aura. You are discussing contraception. You recommend: Mirena IUD One of the main reasons women stop progestin only pills: break through bleeding Sally is post menopausal ands been having frequent UTIs. The NP: recommend vaginal estrace 1gm vaginally weekly David is prescribed sildenafil for ED. Side effects can be? Ischemic optic neuropathy, hearing loss and priapism What are possible side effects of testosterone? Disorders of the liver, prostate cancer, edema, abuse potential, elevated LDL and decreased HDL What is the MOA of alpha adrenergic agents? Blockade of alpha 1 receptors and relaxes smooth muscle in the bladder neck High FBG levels: NPH dose needs to be increased hyperglycemia after breakfast not enough SA insulin or too many carbs or calories at the meal hypoglycemia before lunch intermediate acting insulin is peaking before lunch is eaten or patient not eating enough breakfast hypoglycemia in the afernoon its from the peak and tail of the intermediate acting insulin hyperglycemia in the afternoon intermediate acting insulin needs to be increased or die of lunch is too large hyperglycemia after evening meal short acing insulin needs to be increased hypoglycemia overnight (2-3 am) afternoon NPH is peaking and causing low BS, patient needs less intermediate acting insulin John is a type 1 diabetic and is on insulin glargine at HS and insulin lisper ac each meal. He is having his wisdom teeth removed. How should he manage his insulin? continue the glargine and take lisper only as a supplement Which of the following should be used with caution in a person with a sulfa allergy? glyceride and pioglitazone What is the most common adverse effect noted with alpha-glucosidase inhibitor use? GI upset what of the following should be monitored with a TZD? ALT-liver toxicity The meglitinides are particularly helpful adjuncts in type 2 diabetes to minimize risk of: postprandial hyperglycemia You are prescribing levothyroxine to an elderly 82 yo. Which of the following should you keep in mind?? the levothyroxine dose needed by the elderly is 75% less of what is needed by a young adult Methimazole is primarily excreted by: urine In patients taking anti-thyroid drugs should avoid which of the following? Seafood Vitamin C An important substance needed for proper repair of the skin and tissues; promotes the production of collagen in the skins dermal tissues; aids in and promotes the skins healing process. Found in citrus fruits and vegetables. Antioxidant property and can help with iron as well Niacin Vitamin B3; deficiency can lead to dermatitis, which causes scaling and cracking of the skin, GI and central nervous system disturbances (ataxia) large dose can be used to treat low HDL- s/e of flushing (combative with ASA) Riboflavin (B2) essential for carbohydrate fat and protein metabolism. Necessary for tissue maintenance. And healthy eyes and good for MIGRAINE headaches and can take up to 3 months (400mg Daily) Thiamin Vitamin B1 needed in energy production. Alcoholism is the most common cause of deficiency Paradoxine (B6) coenzyme in AA metabolim, isoiazide interferes with B6 metabolism; deficiency is rare in US except in alcoholics Protein and starchy vegatables Black Cohosh uses menopause vasomotor symptoms; not to be given with selective estrogen modulators Co Q 10 Co Q-10 deficiency (statins), antioxidant, hypertension, heart failure, migraine prevention, Parkinson's cranberry juice helps prevent UTIs, may increase INR in patients taking warfarin Feverfew uses Bolded: Prevention of migraines S/e: platelet agreggations Extras: Rheumatoid arthritis flaxseed small brown seed of the flax plant; used in baking, cereals, or other foods. Valued in nutrition as a source of fatty acids, lignans, and fiber. Helps to lower LDL Garlic Decreases cholesterol and blood pressure Suppresses platelet aggregations. Taken Raw 1-2 cloves daily with elision Ginger Root* Primary use to treat vertigo and N/V associated with Motion sickness. Helps patients with arthritis, lower blood sugar. At high dosages, possible interference with cardiac, antidiabetic, or anticoagulant drugs Ginko (Ginko biloba)* help increase pain free walking in patient with peripheral arterial disease Glucosamine* Made from shellfish. Can cause increased risk of bleeding and bronchospasm. a substance produced naturally in the body; often used as a supplement to maintain cartilage in the joints anyone over the age of 6 should get the flu vaccine: true or false. True out of the shingles (shingreks) it's a recombinate vaccine given in 2 dose. Started at the age of 50 but definitely by age l65. can get flu like symptoms and very sore after injections A good history of herb and supplement use in critical before prescribing because approximately _____% of patients in the us are using herbal products? 38% A potential harmful effect on patients who take some herbal medication is? lead poisoning What black cohosh used for? Treating symptoms of menopause Herbs and supplements are regulated by the US food and Drug administration. True or False False When melatonin is used for sleep, the recommendation is that the patient : Take it no more than 3 nights a week Why is Comfey on the danger list? it can cause veno-occlussive disease. The role of the NP in use of Herbal medication is to: Educate patient and guide them to the appropriate source of care The standard dose of St. John's Wort for the treatment of mild depression is: 300 mg three times daily Pts taking st. john's wort need to be instructed on which of the following drug reactions. Check all that apply MAOI, SSRIs, OTC cough and cold medications Ginseng, chichis taken to assist with memory my potentiate: Insulin Attenuated vaccines are also known as : Live vaccines Live attenuated influenza vaccine (FluMist) may be administered to: All patients over 6 months The reason that 2 MMR vaccines at least a month apart are recommended is: Only 95% of the patients are fully immunized for measles after the first vaccine, with 99% having immunity after 2 doses of MMR The MMR vaccine is not recommended for pregnant women because there is a risk of the fetus developing congenital rubella syndrome The rotovirus vaccine: Is a live vaccine that replicates in the small intestine, providing active immunity against rotovirus. Should not be administered to infants who are or may be potentially immunocompromised. Is not given to an infant who has a febrile illness True contraindications to DTAP or TDAP vaccine include: Anaphylactic reaction with a previous dose Hepatitis B immune globulin is administered to provide passive immunity to: Infants born to HBsAg-positive mothers THe recognition phase of the immune response is: when a mature lymphocyte encounters its matching antigen The activation phase of the immune response is: the lymphocyte undergoes proliferation and differentiation The elimination phase of the immune response is elimination of the antigen T or F: there is a link between MMR and autism FALSE What are the HPV vaccines? Gaurdasil, Gardasil 9 and Cervarix. Gardasil protects against what: Cervical, vulvar, and vaginal in female as well as anal cancer and genital warts in females and males Cervarix protects against what: cervical cancer only but last longer than gardasil Selective estrogen receptor modulators mimic estrogen without targeting breast and uterus Bisphosphonates Fosamax: inhibit bone resorption used in osteoporosis. AE: dysphagia, esophageal ulcer. Nursing: take 1st thing in the morning w/o food, 8oz of water, remain upright for 30mins after taking, if dose missed-skip Vitamin D metabolism skin photoconversion or reabsorbed in gut - 1st hydroxylation in liver - 2nd hydroxylation in kidney's proximal tubule (alpha-1-hydroxylase) Jade is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicated nasal MRSA is muprocin. Patient education regarding treating nasal MRSA includes: Insert one-hand of the dose in each nostril twice a day When prescribing griseofulvin to treat tine capitis it is critical to instruct the patient's parents to: Griseofulvin is best absorbed injested with a high fat food First line therapy for treating topical fungal injections such as tine corporis or tine pedis would be: OTC topical azalea (clotrimazole, miconazole) Erika has been prescribed isotretinoin by her dermatologist and is presenting to you with symptoms of sadness and depression. A beck's Depression Scale indicates she has mild to moderate depression. What would you do at this point? Contact her dermatologist about discounting the isotretinoin David is a 26 year old competitive runner who presents with a complaint of pain in his hip since he fell running. Isotretinoin is the only medication he is taking. he is for severe acne. What should you be concerned for? He is at risk for bone injuries and needs to be evaluated for fracture Jose has had eczema for many years and reports that he thinks his corticosteroid cream is not working as well as it previously was. He may be building a tolerance to the steroids. Treatment options include: Recommend an interrupted or cyclic schedule of application Topical diphenhydramine is available OTC to treat itching. patients or parents should be instructed regarding the use of topical diphenhydramine that: Topical diphenhydramine should not be used in children younger than 2 When prescribing permethrin 5% cream for scabies, patient education should include: all members of the household and person contacts should also be treated Topical immunomodulators such as pimecrolimus or tacrolimus are used for: Short term or intermittent treatment of atopic dermatitis S/E of medication is risk of cancer The goal of therapy when prescribing HRT include: reducing vasomotor symptoms The optimal maximum time for HRT or ERT is: 5 years Angela is an african american female who has heard that women of african descent do not need to worry about osteoporosis. What education would you provide about her risk? Black women are at risk of developing osteoporosis due to their lower calcium intake as a group Drugs that increase the risk of osteoporosis include: Carbamazepine, Glucocorticoids, levothyroxine SERMs (selective estrogen receptor modulators) treat osteoporosis by selectively: Selectively acting on the estrogen receptors in the bone The ongoing monitoring for patients over 65 taking alendronate or any other bisphophonate is: Annual renal function evaluation What is the established frequency of repeating DEXA imaging after starting bisphosphonates? There is no evidence-based time line for monitoring after the first 2 years IV forms of bisphosphonates are used for all the following except: 1. Severe gastric irritation with oral forms 2. Known cancer mets into the bone 3. Persons with advancing renal dysfunction 4. Progression of bone loss on oral formulations 1. Severe gastric irritation with oral forms 2. Known cancer mets into the bone 4. Progression of bone loss on oral formulations Both UVA and UVB rays promote damage to DNA and can cause premalignant actinic keratoses, basal cell, squamous cell and melanoma. True SPF is an index of projection against UVB and UVA radiation False only UVB Tacrolimus and pimecrolimus are used for atopic dermatitis. What do both carry potential for: Both can cause skin cancer and lymphoma Finasteride is an oral drug with what indications: Androgenic alopecia and BPH Johnny has impetigo. You order: mupirocin ointment What are the 3 ways anti ulcer drugs work? Eradicate H. Pylori (antibiotics) Reduce gastric acidity (antisecretory agents, misoprostol) Enhance mucosa defenses (Sucralate, misoprostol) Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: 1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3. Is the treatment of choice for the diarrhea associated with E. coli 0157 4. May be used in pregnancy and by lactating women Sloes gastric motility and reduces fluid and electrolyte loss from diarrhea bismuth subsalicylate is a common OTC remedy for GI complaints. Bismuth subsalicylate: May lead to toxicity if taken with ASA. Has antimicrobial effects against bacterial and viral enteropathogens. Is Contraindicated in children with flu-like illness Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: 1. Loperamide four times a day throughout the trip 2. Bismuth subsalicylate with each meal and at bedtime 3. A prescription for diphenoxylate with atropine to use if she gets diarrhea 4. None of the above 2. Bismuth subsalicylate with each meal and at bedtime Josie is a 5yr old presenting with 48hr n/v/d. unable to keep fluids down and wt is 4 lbs less than last recorded wt. besides IV fluids, her exam warrants use of anti nausea med. which is appropriate Ondansetron Patients on chronic long-term PPI therapy require monitoring for: Iron deficiency anemia (CBC), Vitamin B12, Calcium deficiency (also at risk for PNA) GERD may be aggrevated by the following medication that effects lower esophageal sphincter (LES) tone Estrogen Lifestyle changes are the first step in treatment of GERD. Food or drinks that might aggravate GERD include: Caffeine Metoclopramide (reglan) improves GERD symptoms by: increasing lower esophageal tone Antacids treat GERD by: Increasing gastric PH When treating patients using the "step-down" approach the patient with GERD is taken off of ____ first PPIs if a patient with GERD taking a PPI daily is not improving, The next step would be: PPI twice a day for 8-12 weeks infants with reflux are initially tx with anti reflux maneuvers elevate head of bed An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: PPI twice daily plus clarithromycin plus amoxicillin for 14 days Treatment failure in patients with PUD associated with H. Pylori may be because of: antimicrobial resistance Pernicious anemia is treated with: Vitamin B12 (Cobalamin) Premature infants require iron supplementation with 2mg/kg per day until 12 month Adults get about 325 TID Breastfed infants should receive iron supplementation of: 1 mg/kg/day Education of patients prescribed iron would include: increase fluid and fiber to treat constipation what is folic acid requirement in pregnancy? 800mcg/day patient being treated for folate deficiency require monitoring of: H & H at 1 week and then 8 weeks before beginning IM vitamin B12 therapy, which laboratory values should be obtained? Reticulocyte count, H &H, Iron and Vitamin B12 count Anemia due to chronic renal failure is treated with: Epoetin Alfa Oral decongestants should be discouraged in patients with cardiovascular disease a 19 year old asthmatic is admitted to the ED is severe bronchospasm. The NP should order: a nebulizer beta 2 agonist Regarding the use of long-acting beta 2 agonists (LABAs) which of the following is NOT true? LABAs can be used as mono therapy to relieve bronchospasm in asthma The antitussive dextromethorphan suppresses the cough reflex by: direct action on the cough center Your new 10-year-old patient has asthma, and you decide to treat her with a β2 agonist. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause (A) Direct stimulation of renin release (B) Hypoglycemia (C) Increased cGMP (cyclic guanine monophosphate) in mast cells (D) Skeletal muscle tremor (E) Vasodilation in the skin Increased pulse rate tiotropium bromide is an inhaled anticholinergic used for the treatment of COPD Christy has exercised-induced and mild persistent asthma and is prescribed 2 puffs of albuterol 15 minutes before exercised and as needed for wheezing. One puff per day of beclomethasone is also prescribed. Education regarding her inhalers includes: Beclomethasone needs to be used every day to treat her asthma Montelukast may be prescribed for: A 2 year old child with moderate persistent asthma (no less) a common adverse reaction when using codeine-based antitussives is: Constipation Which medication is most likely to cause bronchoconstriction in an asthma patient? Carvedilol b/c it's nonselective How do H1 and H2 receptors differ? H2 play a role in secretion of gastric acid, H1 receptors play a role in vasodilation and bronchoconstriction what are the adverse effects of H1 antagonist? Dry mouth, constipation, fatigue, confusion, hallucinations in children What is the advantage of using a second generation H1 antagonist rather than a first generation H1 antagonist? They are virtually void of all anticholinergic actions Which of the following are second generation H1 antagonists? cetirizine, fexofenadine, levocetirizine, loratadine susie has been on prednisone 60 mg for 10 days for COPD exacerbation. Does she need a steroid taper? Yes, 50, 40, 30, 20, 10, 5 stop-each dose for about 3 days Fluticasone can possibly cause: epistaxis, slowing of linear growth tessalon (benzonatate) works by decreasing the sensitivity of the respiratory tract stretch receptors Mary brings in her 2 year old who has a cold. The NP OTC cold remedies should be avoided in children under 4 What are 2 major pharm classes in treatment of COPD? Anti-inflammatory agents Bronchodilators Anticholinergics kathy's 8 year old has been diagnosed with moderate persistent asthma. What do you tell her about ICS use? Inhaled steroids can slow growth in children but do not decrease adult height. What are rules of 2 in asthma treatment? Asthma is poorly controlled if: -rescue inhaler is used more than 2 times weekly -night time symptoms more than 2 times per month -has had 2 bursts of oral steroids in last year Ipratropium works by: blocking muscarinic receptors in the bronchi tiotropium is: a long acting inhaled anticholinergic agent approved for maintenance therapy of bronchospasm associated with COPD What FEV1/FVC ration is diagnostic of COPD? 70 of less What are the 6 steps in asthma therapy? SABA always used PRN 1. no daily med needed 2. low dose ICS 3. Low dose ICS + laba or medium dose ICG 4. medium dose ICS +laba 5. high do