NR566/ NR 566 FINAL REVIEW TEST | Latest Update | Questions and Answers | 100 out of 100 | Verified Solutions | 100% Correct |Chamberlain.

..NR566/ NR 566 FINAL REVIEW TEST | Latest Update | Questions and Answers | 100 out of 100 | Verified Solutions | 100% Correct |Chamberlain. Question: 36 yo male who has HIV presents to the office wanting to discuss starting dietary supplements. The NP knows which of the following is contraindicated? A.) Echinacea B.) Kava C.) Ginger Root D.) Flaxseed A) Echinacea Question: When asking a new patient about OTC or herbal medications they take daily the patient states "I just take coenzyme Q-10." The NP knows this is commonly taken to help with _________ A)Constipation B) Menopause symptoms C) Energy boost D) Lowering cholesterol C) Energy Boost Remember this is similar to Vitamin K so watch out if they are taking warferin. Question: What is the Dietary Supplement Act of 1994 (DSHEA)? By classifying products as dietary supplements, the DSHEA exempts them from undergoing FDA scrutiny and approval before marketing term-3 Question: Three weeks ago, a patient who was placed on donepezil 5 mg daily presents to the office today to discuss recent lab work. At the end of the visit she states, "I don't think that medication you put me on for my dementia is working." What would be the best response? A) I will have to refer you to neurology since you don't feel that it is working B) We can increase the dose after you have been on it for 1-3 months C) A dose any higher will cause life threatening reactions D) We can increase that dosage to 10mg today since we started you on the lowest dose. B. We can increase the dose after you have been on it for 1-3 months. This is the treatment for which STI?Benzathine penicillin G 2.4 million units IM once Latent Syphilis pg. 765 Question: The following adverse effects can occur when taking which dietary supplement?Stomach upset, headache, dizziness, vertigo. Possible seizures and fatalities if you eat the seeds. A) Kava B) Ginkgo Biloba C) Ginger Root D) Saw Palmetto B) Ginkgo Bilaba- pg. 624 Question: Which of the following patient conditions would Kava-kava be ABSOLUTELY contraindicated in? A) Hashimoto's thyroiditis B) Hepatotoxicity C) Severe renal disease D) HIV E) None of the above B) Hepatotoxicity pg. 649 Question: What is meant by "abortive therapy" for migraines? When is it used? Eliminate nausea, vomiting and headache. Treatment should be as soon as possible. pg. 195-196 Question: Which of the following are side effects of cholinesterase inhibitors? Select all that apply. A) Dizziness B) Orthostatic hypotension C) Constipation D) Confusion E) Weight loss F) Bradycardia G) Hepatotoxicity A,B,E,F PG. 147 Question: SSRIs and SNRIs are the first line treatment for __________ Generalized Anxiety Disorder pg. 243 Question: What is first line treatment for migraine prevention? A.) Triptans B.) Beta Blockers C.) Ergot Alkaloids D.) Benadryl B. Beta Blockers (Propanolol and metoprolol) pg 195-196 Question: Which patient statement indicates understanding of administration of flaxseed? A.) "I need to have my cholesterol checked every 6 months because it can make it go really high" B.) "Flaxseed can increase the absorption of a few of my daily medications, so I have to wait 30 min between" C.) "I cannot use this because I have a history of thyroid disease" D.) Flaxseed can reduce absorption of two of my daily medications so I should take it 1 hour before or 2 hours after taking my other medicine" d)Flaxseed can reduce the absorption of two of my daily medications so I should take it 1 hour before or 2 hours after taking my other medicine" pg. 643 Question: How would determine if a patient with migraines would be appropriate candidate for preventative therapy? Preventive treatment is indicated for patients who have 1. frequent attacks (three or more a month), ks that are especially severe, or ks that do not respond adequately to abortive agents. Preferred drugs for prophylaxis include propranolol, divalproex, and amitriptyline. All three are effective and well tolerated, and with all three, the benefits take 4 to 6 weeks to develop. Pg. 199 Question: Which medication would be given for someone with epilepsy needing adjunctive therapy for partial seizures with or without secondary generalization? A) Lamotrigine B) Levetiracetam C) Gabapentin D) Pregabalin E) Phenytoin C)Gabapentin pg. 164 Gabapentin has a broad spectrum of antiseizure activity. However, its only FDA-approved use in epilepsy is adjunctive therapy of partial seizures (with or without secondary generalization Question: What is the side effects for Doxazosin orthostatic hypotension, reflex tachycardia, and nasal congestion. profound hypotension, which can be minimized by giving the initial dose at bedtime Question: What is the Patient teaching for Dutasteride 1. Goal is to relieve urinary symptoms, 2. benefits take months to develop, must continue taking med even if the improvement is not rapidly seen 3. The most common adverse effect is sexual lower ejaculatory volume & libido 4. Men should not donate blood while using dutasteride or for at least 6 months after stopping it to avoid transmission to women through the administration of blood products 5. Is teratogenic. It can be absorbed through the skin, so pregnant women should not handle the drug. 6. should not be used for prostate cancer prevention. P.G. 464 Question: How do you know if Terazosin BPH is working improved symptoms of dysuria, urgency, urinary tract infections, hesitancy etc. Question: Benefits of prescribing medroxyprogesterone acetate Protects against pregnancy for 3 months or longer by inhibiting the secretion of gonadotropins. Return of fertility is delayed by an average of 9 months. Benefits outweigh the risk which is no increase in cervical, ovaria, or breast cancer in women and the risk for endometrial cancer is actually reduced. Question: When is it not safe to prescribe Progesterone (Progestin)? NOT SAFE FOR Progesterone 1. Presence of undiagnosed abnormal vaginal bleeding. 2. Active thrombophlebitis or a history of thromboembolic disorders, 3. active liver disease, and 4. carcinoma of the breast. Question: Side effects of progestin-only oral contraceptives? more likely to cause irregular/inconsistent bleeding, must be taken at same time every day to be effective Question: Benefits of prescribing medroxyprogesterone acetate doesn't cause thromboembolic disorders, headaches, nausea, or most of the other adverse effects associated with combo OCs. does not decrease milk supply during lactation Question: Testosterone replacement therapy routes: treatment that involves administering testosterone supplements through pills, injections, or skin patches Question: Testosterone patch patient teaching: good hand washing is required after application ○ cover application site with clothing after medication has dried ○ wash the application site before skin -to-skin contact with another person ■ females and children may experience negative effects from exposure to testosterone ■ if cross contamination occurs, wash the affected area with soap and water to prevent absorption Question: When is androgen therapy appropriate vs. not needed related to puberty? Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress. Long term: if delayed puberty related to true hypogonadism Question: Testosterone replacement therapy side effects? Hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, sterility, hepatotoxicity, mood swings/ aggression Question: Alprostadil: benefits of various routes? (for ED) injection: can be done by patient or in ER setting; rapidly leads to erection, painless intraurethral pellet insertion: can be done by patient, erection occurs within 5-10 mins, minimal side effects Question: How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? accelerates OC metabolism, reducing OC effect can lead to abnormal bleeding, return of menstrual symptoms, and of course pregnancy Question: What can the provider do is carbamazepine effecting patient's OC? 1. Increase the estrogen dosage of the OC. 2. Combine the OC with a second form of birth control. 3. Switch to an alternative form of birth control. Question: Benefits of Etonogestrel subdermal implant (Nexplanon)? it is one of the most effective forms of contraception, long-term option (contraception up to 5 years), reversible by removing rod Question: Papaverine plus phentolamine patient education: do not inject more than once in a 24 hr period, notify provider of erection duration and efficacy, do not take other ED meds with this medication, needle/injection teaching, do not change the dose yourself, seek medical attention if erection is 3 hrs Question: Chlamydia first line drug/dose/route/frequency Azithromycin 1000 mg PO once OR Doxycycline 100 mg PO BID × 7 days Question: Uncomplicated gonococcal urethritis first line drug/dose/route/frequency Ceftriaxone 250-500mg IM once Question: Bacterial Vaginosis first line drug/dose/route/frequency 500 mg Metronidazole PO BID x 7 days Question: Herpes Simplex Virus first line drug/dose/route/frequency - Acyclovir 400 mg PO TID x 7-10 days Question: Trichomonas’s first line drug/dose/route/frequency - women: 500 mg Metronidazole PO BID x 7 days men: 2 g Metronidazole PO once Question: Syphilis first line drug/dose/route/frequency - Penicillin G IV (dose depends on the patient Question: Adverse effects associated with Pramipexole nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, and hallucinations Question: Impulse control disorder can occur excessive gambling, spending etc Question: Sleep attacks overwhelming and irresistible sleepiness that comes on without warning When is Pramipexole best used in treating Parkinson's? early stages of Parkinsons Question: Question: When are COMT inhibitors indicated?I.e. Entacapone) If patient experiences "off" phases with their medication therapy (return of symptoms for random periods of time) Question: What are sleep attacks associated with Parkinsons treatment? overwhelming/irresistible sleepiness that comes on without warning Question: How to manage side effects of Bromocriptine (dopamine agonist): 1. Take with food to decrease GI upset 2. start with lowest effective doseand gradually increase 3. screen for hx of compulsion/sleep disturbance Question: What seizure meds reduce OC efficacy? carbamazepine, eslicarbazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, topiramate Question: Phenytoin side effects drowsiness, ataxia nystagmus blurred vision lethargy GI upset suicidal behavior/cognitive decline patient teaching with Phenytoin strict adherence to medication is important due to its narrow therapeutic range patient teaching regarding anti-seizure meds and OC/pregnancy: 1. effectiveness of OC may be decreased by many anti-seizure meds, if pregnancy is unwanted the pt should consider adding or increasing contraception. 2. lowest dose/lowest number of meds used during pregnancy tends to be most safe. Risk vs benefit! 3. Folic acid is essential How to monitor antiepileptic drugs for effectiveness? Monitoring plasma drug levels and absence of seizures during trial period while finding right medication. Patient should not drive during this time What is abortive migraine therapy and when is it used analgesics (NSAID and opioid) and migraine-specific meds (Triptans and Ergot alkaloids) used to treat migraine pain and associated symptoms used at 1st sign of attack First-line treatment for migraine prevention? - Beta Blockers: Metoprolol or Propranolol First-line treatment for acute, mild to moderate migraine without nausea or vomiting? NSAID: Naproxen or aspirin How to know someone would be appropriate for preventative migraine therapy? Indicated for patients who have frequent attacks (3+ a month), severe attacks, or attacks that do not respond adequately to abortive therapy Opioid analgesic reserved for severe migraines that don't respond to first-line medications? Butorphanol nasal spray; one spray each nostril every 60 minutes prn mechanism of action for sumatriptan: suppresses the release of CGRP from trigeminal neurons lead to vasoconstriction and decreased perivascular inflammation to relieve migraine pain contraindications for triptans Pregnancy, uncontrolled HTN, previous MI, heart disease The first dose of any triptan should be should be under direct supervision in case of any unknown underlying cardiac disease What to do when someone has an elevated creatinine clearance while on Memantine? Adjust dose for renal impairment (creatinine clearance of less than 30mL/min), discontinue in severe renal impairment First-line treatment options for panic disorder? SSRIs- fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) for at least 6-9 months to prevent rebound anxiety First-line treatment options for performance anxiety? beta blockers- Propranolol to prevent associated tachycardia First-line treatment options for generalized anxiety disorder? SSRIs- Paroxetine (Paxil) and Fluoxetine (Prozac) SNRIs- Buspirone (Buspar) Approach when first anti-depression drug doesn't seem to be working? wait at least 4 weeks minimum before increasing/changing dose. 1st increase dose, then change drug within same class, then switch to new class, then start second med How long should it take antidepressants to work? - 4-8 weeks Suicide risk associated with antidepressants: - increased risk of suicide in those taking antidepressants, especially in children and young adults never to be stopped abruptly (increases risk) First-line treatment options for sleep disturbance? Benzodiazepines: Triazolam Benzodiazepine-Like Drugs: Zolpidem (Ambien), Zaleplon (sonata), eszopiclone (Lunesta) Melatonin Receptor Agonist: Melatonin, Ramelteon (Rozerem) Orexin Receptor Agonist: Suvorexant (Belsomra) Therapeutic drug level of lithium: 0.6-0.8 mEq/L Lithium drug-drug interactions 1. Thiazides -Diuretics- lithium toxicity 2. NSAIDS - higher plasma lithium levels 3. Haloperidol -encephalopathic syndrome (weakness, tremors, confusion, lethargy) -Carbamazepine 4. anti acids-decreases effectiveness of lithium Common adverse reactions of 1st generation antipsychotics extrapyramidal symptoms: Parkinsonism, akathisia, dystonia (all manageable w/ anticholinergics), Tardive Dyskinesia (no treatment) dry mouth, constipation (anticholinergic effects) pt teaching regarding first gen. antipsychotics: inform provider immediately about any signs/symptoms of tardive dyskinesia/adverse effects sunscreen use Drug-Drug Interactions of SSRIs +MAOIs- can cause serotonin syndrome Fluoxetine- not to be taken w/ warfarin or lithium Baseline data needed to prescribe SSRIs/SNRIs: Na levels in pt on diuretics Common adverse effects of SSRIs: sexual dysfunction, n/v, agitation, insomnia, weight gain Ways to manage SSRI adverse effects? sexual dysfunction: add Bupropion, drug holidays weight gain: diet, lifestyle changes n/v: take with food Baseline Baseline data needed to prescribe Tricyclic Antidepressants (TCAs)? EKG especially in those w/ dysrhythmias or 40+ years old Patient education needed for TCAs Educate patients regarding orthostatic hypotension and anticholinergic effects, including dry mouth, blurred vision, constipation, and urinary hesitancy. Baseline data needed to prescribe MAOIs: baseline BP Patient education for MAOIs: Educate patients on foods containing tyramine (DO NOT EAT THESE) and to report signs of hypertensive crisis (nausea, vomiting, profuse sweating, severe headache) immediately. What foods contain tyramine? Avocados, aged meats, bean curd, bananas, cold cuts/sausages, cured fish, cheese, yeast, beers, protein supplements, soups, shrimp, soy sauce, chocolate, caffeine Symptoms of serotonin withdrawal: dizziness, headache, nausea, sensory disturbances, tremor, anxiety, and dysphoria What is the first line treatment for bacterial vaginosis (BV)? pg. 755 A 25-year-old female presents to the office stating she has a few presentations coming up for school over the next year and cannot control her nerves. States she got a bad grade on the last one because "my mind went blank." She denies anxiety on a regular basis. What is the likely diagnosis?Which of the following would be first line treatment? A) Venlafaxine B) Propranolol C) Sertraline D) Xanax Social Anxiety Disorder (C) pg. 246 What is the first line treatment for someone presenting with their first clinical episode of genital herpes (HSV-2) pg. 765 You have determined that a patient is a candidate for opioid analgesic therapy for migraines. Which opioid analgesic would be MOST appropriate? A) Hydrocodone-acetaminophen B) Tramadol C) Butorphanol nasal spray D) None of the above C- pg. 196 What are some common side effects of Phenytoin? How can Phenytoin affect birth control? CNS- sedation , drug reaction , club palet..... pg. 156-158 Which medication would be best to prescribe to your 30 yo male patient who has both depression and decreased libido? A) Duloxetine B) Sertraline C) Escitalopram D) Bupropion B 216 Which patient statement would indicate understanding of dutasteride? A)"It is not absorbed through the skin so its ok that my daughter is pregnant. She handles putting all my medications in my pill box." B) "I cannot donate blood while taking this medication for at least 6 months" C) "This medication will not affect my libido like finasteride would." D) "This medication may cause a slight incline in my PSA number but that is to be expected." B. pg 464 Patient Education A patient with BPH who states, "just after a few days I noticed my urine stream wasn't as delayed and the urine flow was a lot stronger." Which medication was he likely prescribed? A) Tadalafil B) Terazosin C) Dutasteride D) Alprostadil b 465 Which of the following is the major drawback of progestin only oral contraceptives? A) Inconsistent cycle length B) Variations in volume and duration of monthly flow C) Irregular bleeding D) Nausea and vomiting E) None of the above C 442 A 68 yo female presents with depression and chronic pain. Which medication would best benefit these symptoms? A) Sertraline B) Escitalopram C) Bupropion D) Duloxetine E) Seroquel D Which medication would be best to prescribe to a patient with depression AND insomnia? A) Bupropion B) Nefazodone C) Selegiline D) Mirtazapine D 216 What is the outpatient treatment for a patient with pelvic inflammatory disease (PID)? pg. 764 Which four drug classes can be prescribed for panic disorder (PD)? SSRI, SNRI, TCA, MAO1 .... Which class of medication is preferred for Panic Disorder? SSRI Which medications in the preferred class are approved for Panic Disorder? SSRI - Prozac, Paxil and Zoloft pg. 245 Medications in which THREE drug classes can cause drug-drug interactions with lithium? 1. NSAIDS 2. Diuretic 3. Anticholinergic pg. 231-232 Which symptoms below would the dietary supplement "Feverfew" help with? Select all that apply. A.) Migraine prophylaxis B.) Acne C.) Heart health D.) Seasonal allergies E.) Asthma F.) Burns G.) Rheumatoid Arthritis H.) Psoriasis F.) B, F, E only A, B E G H PG. 642 What would your response be to a patient who you know is taking carbamazepine for severe epilepsy that asks about being started on an oral contraceptive due to a new relationship? 1. Increase the effects of the oral contraceptive, 2.Advice them of the need risk of more contraceptives if pregnancy is not resired. pg. 155 One week ago, you saw a 27 yo female who you prescribed escitalopram 10mg daily for depression/anxiety. She calls the office today asking to talk to you. She states "this medication that you gave me last week is not helping at all. I am still having all the same symptoms." What is your response? A) "This medication takes 10 days to improve symptoms" B) "This medication takes about 6 weeks to work" C) "This medication takes about 1-3 weeks to notice a difference" D) "It should be working. Let's make an appointment to increase the medication dosage." C. pg. 215 Which of the following is a significant benefit of Depot Medroxyprogesterone Acetate? A) Reduces risk of endometrial cancer B) Reduces the risk of cervical cancer C) Reduces the risk of breast cancer D) Reduces the risk of ovarian cancer A. pg. 443 A 67 yo male patient presents to the office after starting a daily dietary supplement about a month ago. He is c/o of insomnia, vivid dreams, restlessness, anxiety, agitation, irritability, abdominal pain, dry mouth and headache. The NP asks if he is taking which supplement? A) Valerian B) Kava C) Ginkgo Biloba D) St. Johns Wart E) A&B D. pg 648 Nexplanon is safe to use while breastfeeding and has no effects on the quality or quantity of milk produced TRUE or False True pg. 443 When prescribing alprostadil (Prostaglandin E1) the NP knows that it comes in which preparations? A) Transurethral, oral, and gel B) Intracavernous only C) Transurethral and intracavernous D) Gel and intracavernous C pg 459 1.) What is pramipexole (Mirapex) used to treat? (Approved for two indications) 2.) When is it most beneficial? 3.) What are the most common adverse effects when used alone? 1. Parkinson and RLS 2. When it is used with early stages PD and combined with Levodopa. Used in advance PD or Restless leg syndrome. 3.Nausea dizziness, daytime somnia, weakness,pg. 137 Lithium levels must be kept below ___________ A) 1.2 mEq/L B) 1.5 mEq/L C) 0.4 mEq/L D) 2.0 mEq/L B. 231 Which sleep med would help patients fall asleep if they don't have trouble staying asleep? Ambium ... pg. 241 When prescribing a patient with Alzheimer's on ___________ you know a dosage adjustment is required for patients with renal impairment having a creatine clearance of less than 30 mL/min. numenbium pg. 149 1.) What drug class is Entacapone (comtan)? 2.) When do you use/prescribe Entacapone? 1. SOMP Inhibitor 2. USED WITH LEVODOPA..... pg. 138 What is the black box warning for antidepressants? SUICIDE INCREASE EARLY ON. pg, 216 What are the various routes of estrogen therapy? oral, transdermal, intra vaginal, pg. 428-429 Name some benzodiazepine-like drugs Ambiem, pg. 237 Name a melatonin receptor agonist What is papaverine plus phentolamine used for? Erection. orthostaic hypotension pg. 460 Provide patient education for this medication What is the first line drug class for treating sleep disorders? Benzo pg. 234 What is the MOA of sumatriptan? pg. 198 What are the two main adverse effects of Ginger Root? CNS DEPRESSION CARDIAC DISRHYTHMIAS PG. 644 SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants are the 5 major classes that are used to treat ________________? 2. WHAT IS THE USUAL DRUG OF CHOICE? 3. WHAT IF THE DRUG OF CHOICE DOES NOT WORK OR AREN'T TOLERATED BY THE PATIENT? 1. Depression 2.SSRI, SNRIs, buperpotum, 3. TCA, MAOIs p.g. 214 For Dietary supplements there is no assurance that the product contains what the label proclaims: the package may contain ingredients that are not listed, or it may lack ingredients that are listed. These shortcomings and others have been addressed by the ____________ A.) Current Good Manufacturing Practices (CGMP) ruling of 2007 B.) Dietary Supplement Health and Education Act (DSHEA) of 1994 C.) Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 D.) FDA A. pg. 638 This is the first-line treatment for which STI? Ceftriaxone 250 mg IM once, PLUS azithromycin 1g PO once pg. 764 When is androgen therapy appropriate vs not needed related to puberty pg. 450 Which of the following is not a common side effect of Doxazosin? A) Hypotension B) Fainting C) Somnolence D) Nasal congestion E) Decreased Libido E. pg. 465 Which medication would be best to prescribe for a patient with depression AND fatigue? A) Venlafaxine B) Risperidone C) Fluoxetine D) Bupropion E) Both C & D F) All of the above are good choices E. Which of the following patients would progestin use be contraindicated? Select all that apply. A) 24 yo female with family history of ovarian cancer B) 30 yo female with abnormal vaginal bleeding without known cause C) 50 yo female with kidney disease D) 39 yo female with history of DVTE) 4o yo female with breast cancer F) 60 yo female with cirrhosis BDEF pg. 431 _______________ mandates the reporting of serious adverse events for nonprescription drugs and dietary supplements. The following should be reported: deaths, hospitalizations, life-threatening experiences, persistent or significant disabilities and birth defects. A.) Current Good Manufacturing Practices (CGMP) ruling of 2007 B.) Dietary Supplement Health and Education Act (DSHEA) of 1994 C.) Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 D.) Mandatory Event Reporting of Dietary Supplements Act of 2001 c pg 639 Name some benzodiazepines diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax) pg. 238 Azithromycin 1 g PO or Doxycycline 100 mg PO BID x 7 days is first line treatment for with STI Chlomedia for adult 763-764 1.What drug class is bromocriptine? 2.What is it used to treat? 3.How can side effects be managed? Pg. 138-139 1. Argite 2. PD 3. low and gradual increase Overwhelming and irresistible to sleepiness comes without warning is called Parkinson Disease, and is an adverse effect of ? pg. 137 What are adverse effects of triptans? The first dose of triptan should be under ________ _______________ in case of any unknown or underlying __________________ ________________________ 1. Direct Supervision 2.Cardiac pg. 198 What medication are used for abortive therapy of mild headache symptoms NSAID (e.g., aspirin, naproxen) What Medication are used for Moderate to severe headaches Moderate-serotonin1B/1D agonist, or—less frequently used—an ergot alkaloid (ergotamine or dihydroergotamine) severe- opioids e.g., butorphanol) pg. 196 When is it safe to take Progesteron 1. management of dysfunctional uterine bleeding, 2. amenorrhea, and endometriosis; and rt of pregnancy in women with corpus luteum deficiency. 4. Progestins are also used in in vitro fertilization cycles and to prevent prematurity in women at high risk for preterm birth.