Exam 3: NURS 615/ NURS615 (Latest 2024/ 2025
Update) Advanced Pharmacotherapeutics Review |Qs
& As| 100% Correct| Grade A (Verified Answers)-
Maryville
Carbamazepine (Tegretol) black box warnings - ANSWER-severe derm rxns (SJS and
toxic epidermal necrolysis)
-agranulocytosis and aplastic anemia
Who is more at risk for SJS with Tegretol? - ANSWERAsian decent at increased risk
people taking valproic acid (Depakote) at risk for: - ANSWERLiver failure
(lawsuit r/t someone taking depakote and went into liver failure, as provider had
never checked liver function)
nonselective NSRIs: Trycyclic antidepressant meds - ANSWER-amitriptyline
-nortriptyline
-imipramine
-doxepin
SSRI exampls - ANSWER-fluoxetine
-paroxetine
-sertraline
-fluvoxamine
-citalopram
-escitalopram
SNRI examples - ANSWER-venlafaxine (effexor)
-duloxetine (cymbalta)
-milnacipran (savella)
-desvenlafaxine (Pristig)
SSRI pharmacodynamics - ANSWER-selective inhibitory effects on presynaptic
serotonin re-uptake
-weak effect on norepinephrine and dopamine neuronal uptake
SSRI pharmacokinetics - ANSWER-slow absorption
-extensive first pass metabolism
SSRI half life - ANSWERusually up to 26 hours
Fluoxetine half life
fluoxetine first metabolite - ANSWER1/2 life : 1-3 days
First metabolite: 4-16 days
,meds that may cause serotonin syndrome when combined with SSRIs/SNRIs -
ANSWER-St johns wort
-tramadol
Antidepressant education - ANSWER-avoid alcohol with SSRI/SNRI
-long taper when stopping
-when changing med, 50% every 3 days
Antidepressant approved in children - ANSWERFluoxetine
Examples of atypical antidepressants - ANSWER1. Bupropion
2. Mirtazapine
Mirtazapine (atypical antidepressant) MOA - ANSWER-exact MOA unknown
-antagonist of 5-HT2, 5-HT3 and histamine (H1) receptors
Bupropion and mirtazapine pharmacokinetics - ANSWER-both extensively
metabolized via CYP2D6
Bupropion contraindications - ANSWERactive eating disorder, seizure disorder,
currently on an MAOI
first-line tx for headaches - ANSWERNaproxen
Sumatriptan contraindications - ANSWERPregnancy!
Sumatriptan dosing - ANSWERno more than 2 doses in 24 hours
tx for cluster headaches - ANSWERoxygen
Cause rebound headaches - ANSWERheavy use of NSAIDS
when to refer to specialist for HA - ANSWER-new onset after age 65
-"worst headache of my life"
-changes in cognition
-worsening headache with fever
pts with migraine aura at increased risk for: - ANSWERstroke in the future
meds contraindicated in migraine with aura - ANSWERoral contraceptive pills due to
stroke risk
who is at risk for polypharmacy? - ANSWER-elderly
-people with many comorbid diseases
Impact of polypharmacy - ANSWER-poor med compliance due to high disease
burden
, -risk for side effects/med interactions/adverse drug reaction
-higher risk for falls in elderly
-increased hospital readmissions
-increased mortality
anabolic steroid contraindications - ANSWER-male breast cancer
-prostate cancer
-pregnancy (CATEGORY X)
-Lactation
-transdermal not used in women
androgen ADRs (liver) - ANSWER-hepatitis
-hepatic neoplasm
-cholestatic hepatitis
-jaundice
-hepatocellular carcinoma
androgen ADRs in men - ANSWER-gynecomastia
-reduced sperm levels
-decreased libido at high levels
-depression
androgens in older men increase risk for: - ANSWERMI
androgen ADRs in women - ANSWER-menstrual irregularities
-virilization (develop male characteristics)
effects of estrogen - ANSWER-positive effects on bone mass
-increases serum triglycerides
-improves ratio of HDL to LDL
-stimulates coagulation and fibrinolytic pathways
-results in normal skin and blood vessel structure
-reduces bowel motility
-causes edema (action on RAAS)
-Maintains stability of the thermoregulatory center (hot flashes)
length of hormone replacement therapy - ANSWERno longer than 5 years
Estrogen contraindications - ANSWER-active PE or DVT
-hx or stroke or MI in past year
-liver dysfunction
-smoking
-women with intact uterus
-pregnancy
-breast cancer
-estrogen-dependent cancers
Update) Advanced Pharmacotherapeutics Review |Qs
& As| 100% Correct| Grade A (Verified Answers)-
Maryville
Carbamazepine (Tegretol) black box warnings - ANSWER-severe derm rxns (SJS and
toxic epidermal necrolysis)
-agranulocytosis and aplastic anemia
Who is more at risk for SJS with Tegretol? - ANSWERAsian decent at increased risk
people taking valproic acid (Depakote) at risk for: - ANSWERLiver failure
(lawsuit r/t someone taking depakote and went into liver failure, as provider had
never checked liver function)
nonselective NSRIs: Trycyclic antidepressant meds - ANSWER-amitriptyline
-nortriptyline
-imipramine
-doxepin
SSRI exampls - ANSWER-fluoxetine
-paroxetine
-sertraline
-fluvoxamine
-citalopram
-escitalopram
SNRI examples - ANSWER-venlafaxine (effexor)
-duloxetine (cymbalta)
-milnacipran (savella)
-desvenlafaxine (Pristig)
SSRI pharmacodynamics - ANSWER-selective inhibitory effects on presynaptic
serotonin re-uptake
-weak effect on norepinephrine and dopamine neuronal uptake
SSRI pharmacokinetics - ANSWER-slow absorption
-extensive first pass metabolism
SSRI half life - ANSWERusually up to 26 hours
Fluoxetine half life
fluoxetine first metabolite - ANSWER1/2 life : 1-3 days
First metabolite: 4-16 days
,meds that may cause serotonin syndrome when combined with SSRIs/SNRIs -
ANSWER-St johns wort
-tramadol
Antidepressant education - ANSWER-avoid alcohol with SSRI/SNRI
-long taper when stopping
-when changing med, 50% every 3 days
Antidepressant approved in children - ANSWERFluoxetine
Examples of atypical antidepressants - ANSWER1. Bupropion
2. Mirtazapine
Mirtazapine (atypical antidepressant) MOA - ANSWER-exact MOA unknown
-antagonist of 5-HT2, 5-HT3 and histamine (H1) receptors
Bupropion and mirtazapine pharmacokinetics - ANSWER-both extensively
metabolized via CYP2D6
Bupropion contraindications - ANSWERactive eating disorder, seizure disorder,
currently on an MAOI
first-line tx for headaches - ANSWERNaproxen
Sumatriptan contraindications - ANSWERPregnancy!
Sumatriptan dosing - ANSWERno more than 2 doses in 24 hours
tx for cluster headaches - ANSWERoxygen
Cause rebound headaches - ANSWERheavy use of NSAIDS
when to refer to specialist for HA - ANSWER-new onset after age 65
-"worst headache of my life"
-changes in cognition
-worsening headache with fever
pts with migraine aura at increased risk for: - ANSWERstroke in the future
meds contraindicated in migraine with aura - ANSWERoral contraceptive pills due to
stroke risk
who is at risk for polypharmacy? - ANSWER-elderly
-people with many comorbid diseases
Impact of polypharmacy - ANSWER-poor med compliance due to high disease
burden
, -risk for side effects/med interactions/adverse drug reaction
-higher risk for falls in elderly
-increased hospital readmissions
-increased mortality
anabolic steroid contraindications - ANSWER-male breast cancer
-prostate cancer
-pregnancy (CATEGORY X)
-Lactation
-transdermal not used in women
androgen ADRs (liver) - ANSWER-hepatitis
-hepatic neoplasm
-cholestatic hepatitis
-jaundice
-hepatocellular carcinoma
androgen ADRs in men - ANSWER-gynecomastia
-reduced sperm levels
-decreased libido at high levels
-depression
androgens in older men increase risk for: - ANSWERMI
androgen ADRs in women - ANSWER-menstrual irregularities
-virilization (develop male characteristics)
effects of estrogen - ANSWER-positive effects on bone mass
-increases serum triglycerides
-improves ratio of HDL to LDL
-stimulates coagulation and fibrinolytic pathways
-results in normal skin and blood vessel structure
-reduces bowel motility
-causes edema (action on RAAS)
-Maintains stability of the thermoregulatory center (hot flashes)
length of hormone replacement therapy - ANSWERno longer than 5 years
Estrogen contraindications - ANSWER-active PE or DVT
-hx or stroke or MI in past year
-liver dysfunction
-smoking
-women with intact uterus
-pregnancy
-breast cancer
-estrogen-dependent cancers
