ANCC GEORGETTE REVIEW FOR BOARDS EXAM
NEWEST EXAM 130 QUESTIONS AND CORRECT
DETAILED ANSWERS (100% VERIFIED ANSWERS) |
ALREADY GRADED A+
Potent Inhibitors: CYP450 System - ANSWER: Macrolides (erythromycin,
clarithromycin, telithromycin)
Antifungals (ketoconazole, fluconazole, itraconazole)
Cimetidine (Tagamet)
Citalopram (Celexa)
Protease inhibitors (saquinavir, indinavir, nelfinavir)
Grapefruit juice
Narrow Therapeutic Index Drugs - ANSWER: ■Warfarin sodium (Coumadin): monitor
INR.
■ Digoxin (Lanoxin): monitor digoxin level, EKG, electrolytes (potassium,
magnesium, calcium).
■ Theophylline: monitor blood levels.
■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels.
■ Levothyroxine: monitor TSH.
■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism).
Beers Criteria - ANSWER: Antipsychotics: Quetiapine, clozapine, and pimavanserin
may be used with caution.
Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct oral
anticoagulants.
Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic
hormone secretion.
Opioids: Do not combine with benzodiazepines or gabapentinoids, as they increase
the risk of severe respiratory depression.
s/sx of digoxin toxicity - ANSWER: Initial symptoms are GI (nausea/vomiting),
hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or
tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with 2:1
block). Others include confusion and visual changes (yellowish-green-tinged color
vision).
Digoxin therapeutic range - ANSWER: 0.5-2 mg
Warfarin INR range issues - ANSWER: Consistently Stable INR
, Check every 2 to 4 weeks up to every 12 weeks.
Single Out-of-Range INR
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above
therapeutic INR (2-3), experts suggest continuing current warfarin dose; retest INR
within 1 to 2 weeks.
INR <5 With No Significant Bleeding Risk
Omit one dose and/or reduce maintenance dose slightly; recheck INR.
DOACs: Antidotes - ANSWER: idarucizumab and andexanet alfa: reverse the
anticoagulant effects of dabigatran and FXa inhibitors, respectively. Fresh frozen
plasma and prothrombin complex concentrate can also be used for rapid reversa
2017 ACC/AHA stages of hypertension - ANSWER: Normal BP: Systolic <120 mmHg
and diastolic <80 mmHg
Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg
Thiazide diuretics contraindication - ANSWER: Sulfa allergy
(Caution with gout, diabetes)
Also loop diuretics contraindicated with sulfa allergy
Patients with both ____, and ______ receive an extra benefit from thiazides. -
ANSWER: hypertension, osteoporosis
Potassium sparing diuretics black box warning - ANSWER: Hyperkalemia, which can
be fatal; higher risk with renal impairment, diabetes, elderly, severely ill
With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated
because of high risk of hyperkalemia. - ANSWER: renal /CKD
Loop Diuretics Adverse Effects - ANSWER: Electrolytes (hypokalemia, hyponatremia,
hypomagnesemia, and low levels of chlorine)
Hypovolemia and hypotension (dizziness, lightheadedness)
Pancreatitis, jaundice, and rash
Ototoxicity (worsens aminoglycoside ototoxicity effect if combined)
cardioselective beta blockers - ANSWER: metoprolol, atenolol
Non-cardioselective beta blockers - ANSWER: Propanolol, cardivalol
-Blocks both beta 1 + beta 2 receptors (in lungs)
-Don't give to person w/ resp illness including asthma, emphysema, chronic
bronchitis
-If block beta 2 receptors → causes bronchoconstriction, increased airway resistance
→ creates bigger problem than already have if resp problem
NEWEST EXAM 130 QUESTIONS AND CORRECT
DETAILED ANSWERS (100% VERIFIED ANSWERS) |
ALREADY GRADED A+
Potent Inhibitors: CYP450 System - ANSWER: Macrolides (erythromycin,
clarithromycin, telithromycin)
Antifungals (ketoconazole, fluconazole, itraconazole)
Cimetidine (Tagamet)
Citalopram (Celexa)
Protease inhibitors (saquinavir, indinavir, nelfinavir)
Grapefruit juice
Narrow Therapeutic Index Drugs - ANSWER: ■Warfarin sodium (Coumadin): monitor
INR.
■ Digoxin (Lanoxin): monitor digoxin level, EKG, electrolytes (potassium,
magnesium, calcium).
■ Theophylline: monitor blood levels.
■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels.
■ Levothyroxine: monitor TSH.
■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism).
Beers Criteria - ANSWER: Antipsychotics: Quetiapine, clozapine, and pimavanserin
may be used with caution.
Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct oral
anticoagulants.
Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic
hormone secretion.
Opioids: Do not combine with benzodiazepines or gabapentinoids, as they increase
the risk of severe respiratory depression.
s/sx of digoxin toxicity - ANSWER: Initial symptoms are GI (nausea/vomiting),
hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or
tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with 2:1
block). Others include confusion and visual changes (yellowish-green-tinged color
vision).
Digoxin therapeutic range - ANSWER: 0.5-2 mg
Warfarin INR range issues - ANSWER: Consistently Stable INR
, Check every 2 to 4 weeks up to every 12 weeks.
Single Out-of-Range INR
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above
therapeutic INR (2-3), experts suggest continuing current warfarin dose; retest INR
within 1 to 2 weeks.
INR <5 With No Significant Bleeding Risk
Omit one dose and/or reduce maintenance dose slightly; recheck INR.
DOACs: Antidotes - ANSWER: idarucizumab and andexanet alfa: reverse the
anticoagulant effects of dabigatran and FXa inhibitors, respectively. Fresh frozen
plasma and prothrombin complex concentrate can also be used for rapid reversa
2017 ACC/AHA stages of hypertension - ANSWER: Normal BP: Systolic <120 mmHg
and diastolic <80 mmHg
Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg
Thiazide diuretics contraindication - ANSWER: Sulfa allergy
(Caution with gout, diabetes)
Also loop diuretics contraindicated with sulfa allergy
Patients with both ____, and ______ receive an extra benefit from thiazides. -
ANSWER: hypertension, osteoporosis
Potassium sparing diuretics black box warning - ANSWER: Hyperkalemia, which can
be fatal; higher risk with renal impairment, diabetes, elderly, severely ill
With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated
because of high risk of hyperkalemia. - ANSWER: renal /CKD
Loop Diuretics Adverse Effects - ANSWER: Electrolytes (hypokalemia, hyponatremia,
hypomagnesemia, and low levels of chlorine)
Hypovolemia and hypotension (dizziness, lightheadedness)
Pancreatitis, jaundice, and rash
Ototoxicity (worsens aminoglycoside ototoxicity effect if combined)
cardioselective beta blockers - ANSWER: metoprolol, atenolol
Non-cardioselective beta blockers - ANSWER: Propanolol, cardivalol
-Blocks both beta 1 + beta 2 receptors (in lungs)
-Don't give to person w/ resp illness including asthma, emphysema, chronic
bronchitis
-If block beta 2 receptors → causes bronchoconstriction, increased airway resistance
→ creates bigger problem than already have if resp problem
