Exam 4: NR 566/ NR566 (New 2026/ 2027 Update) Advanced Pharmacology Fundamentals for Care of the Family Review| Q&A| Grade A| 100% Correct (Verified Solutions)- Chamberlain

Exam 4: NR 566/ NR566 (New 2026/ 2027 Update) Advanced Pharmacology Fundamentals for Care of the Family Review| Q&A| Grade A| 100% Correct (Verified Solutions)- Chamberlain Q. 1) In CKD, first-line agents to reduce proteinuria and slow progression are: ANSWER B. ACE inhibitors or ARBs Q. 2) The electrolyte abnormality most responsible for malignant ventricular arrhythmia risk in CKD is: ANSWER B. Hyperkalemia Q. 3) Which complication of CKD is primarily due to reduced erythropoietin production? ANSWER B. Anemia Q. 4) Uremic pericarditis in CKD results from: ANSWER B. Accumulated nitrogenous wastes Q. 5) The major driver of secondary hyperparathyroidism in CKD is: ANSWER B. Hyperphosphatemia with low calcitriol Q. 6) Sodium handling in CKD is impaired. A common downstream clinical effect is: ANSWER B. Hypertension and edema Q. 7) Appropriate first step when starting epoetin alfa for CKD anemia: ANSWER B. Ensure iron sufficiency and check ferritin and TSAT Q. 8) Black box warning for epoetin alfa includes increased risk of: ANSWER B. Venous thromboembolism, MI, stroke, and death Q. 9) Which is a contraindication to epoetin alfa initiation in CKD? ANSWER B. Uncontrolled hypertension Q. 10) The earliest expected lab change after starting epoetin alfa is: ANSWER B. Reticulocytosis within about 10 days Q. 11) Best counseling for epoetin alfa storage and handling: ANSWER C. Do not shake. Protect from light Q. 12) Sodium polystyrene sulfonate decreases serum potassium primarily by: ANSWER C. Cation exchange in the gut with fecal K+ elimination Q. 13) A serious GI adverse effect associated with SPS is: ANSWER B. Ischemic colitis and colonic necrosis Q. 14) Avoid coadministration of SPS with which agent because of increased colonic injury risk: ANSWER A. Sorbitol Q. 15) SPS should be avoided in: ANSWER B. Obstructive bowel disease Q. 16) Calcium acetate lowers phosphate by: ANSWER B. Binding dietary phosphate in the gut Q. 17) Key on-therapy risk with calcium acetate in ESRD: ANSWER B. Hypercalcemia and vascular calcification Q. 18) Which drug's absorption can be reduced by calcium acetate binding? ANSWER A. Levothyroxine Q. 19) Dose timing advice for calcium acetate: ANSWER B. Take with meals Q. 20) Cinacalcet mechanism of action is best described as: ANSWER B. Calcimimetic increasing CaSR sensitivity to Ca Q. 21) The most common adverse effect with cinacalcet is: ANSWER B. Nausea and vomiting Q. 22) Absolute contraindication for cinacalcet: ANSWER A. Severe hypocalcemia Q. 23) Key interaction that raises cinacalcet levels: ANSWER B. Ketoconazole Q. 24) Which lab should be checked within one week of cinacalcet initiation or dose change? ANSWER B. Serum calcium Q. 25) Phenazopyridine provides: ANSWER B. Local urinary analgesia with discoloration of urine Q. 26) A key counseling point with phenazopyridine is: ANSWER B. Urine and tears may turn orange or red Q. 27) Phenazopyridine is relatively contraindicated during breastfeeding due to risk of: ANSWER B. Methemoglobinemia and hemolysis, especially in G6PD deficiency Q. 28) Oxybutynin primarily improves urge incontinence by: ANSWER C. Antagonizing M3 muscarinic receptors on detrusor Q. 29) A common reason to avoid oxybutynin in a 49-year-old male with OAB is: ANSWER B. Narrow angle glaucoma Q. 30) Older adults on oxybutynin are at higher risk of: ANSWER B. Cognitive impairment and confusion Q. 31) Oxybutynin typical adult ER starting dose is: ANSWER B. 5 mg once daily Q. 32) Mirabegron treats OAB through: ANSWER B. Beta-3 agonism that relaxes detrusor Q. 33) When selecting mirabegron instead of oxybutynin, the most compelling reason is: ANSWER B. Patient has narrow angle glaucoma or intolerable anticholinergic effects Q. 34) Key safety consideration with mirabegron: ANSWER B. Elevated blood pressure Q. 35) Tamsulosin improves BPH symptoms primarily by: ANSWER B. Relaxing smooth muscle in prostate and bladder neck Q. 36) Tamsulosin is best taken: ANSWER A. 30 minutes after the same meal each day Q. 37) A common adverse effect uniquely notable with tamsulosin: ANSWER B. Retrograde ejaculation or decreased ejaculate volume Q. 38) Doxazosin may be chosen over tamsulosin when: ANSWER A. Coexisting hypertension would benefit from BP lowering Q. 39) Finasteride improves LUTS in BPH mainly by: ANSWER B. Reducing DHT and shrinking the prostate over months Q. 40) Important counseling for finasteride: ANSWER C. Teratogenic. Avoid handling crushed tablets in pregnancy Q. 41) Which combination is accurate for Darius with enlarged smooth prostate and severe LUTS? ANSWER A. Start finasteride 42) For Ohon with moderate LUTS, normal BP, smooth prostate, first-line choice: A. Tamsulosin 0.4 mg daily 43) For Cyrus with BPH and elevated BP, reasonable initial option is: B. Doxazosin 44) For Caoimhe with urge incontinence after negative workup, first medication choice per CPG: A. Oxybutynin ER 45) For Asante with OAB and narrow angle glaucoma, initial drug choice: B. Mirabegron 46) For Dae, age 6, urgent frequency and nocturia, meds after failed behavioral therapy: B. Mirabegron pediatric dosing 47) Which is the best monitoring plan after starting tamsulosin? B. Reassess IPSS and post-void residual in 4 to 12 weeks 48) PSA testing with finasteride therapy should be: B. Checked before therapy and about 6 months after 49) Which pairing is correct regarding drug and interaction risk? A. Tamsulosin with cimetidine may increase tamsulosin levels 50) Which statement about phenazopyridine is correct? B. Limit unsupervised use to short courses and combine with antibiotics when indicated Schedule IV Controlled Drugs for Weight Loss: Diethylpropion Lorcaserin Phentermine/topiramate (topiramate is not a controlled drug) Not Controlled Drugs for Weight Loss: Orlistat-OTC Naltrrexone/Bupropion Liraglutide Which non-amphetamines are FDA approved for weight loss that have lower abuse risk? Phentermine Diethylpropion How do Phentermine & Diethylpropion promote weight loss? Phentermine & Diethylproprion promote weight loss by decreasing appetite. CNS stimulants that suppress appetite by increasing the availability of norepinephrine at receptors in the brain How long should duration of Phentermine & Diethylpropion be limited to? Preferred duration is 3mo or less What drug schedule do Phentermine & Diethylpropion fall under? Schedule IV medications What labs should be monitored with Phentermine & Diethylpropion use and what condition should be screened for? baseline CMP monitor for depression Phentermine common adverse effects include: tachycardia, hypertension, dry mouth and constipation Phentermine/Topiramate is associated with the greatest amount of weight loss of all the drugs, what is its role in weight loss? Increases satiety What are some contraindications for Phentermine/Topiramate use? -It is not approved for children -severe hepative impairement How should we educate pateints to take this medication to avoid insomnia? educate that insomnia is a side effect -encourage them to take before 1600 When do we taper pateints off this med? If ____ % weight loss is not achieved, tolerance can develop within ___ weeks. if 5% weight loss is not achieved, tolerance is likely the cause which can develop in 6-12 weeks What are some high-risk patient conditions that we shold use Phentermine/Topiramate with caution? hx of drug abuse, glaucoma, pregnant, HTN, hyperthyroidism Phentermine/Topiramate common adverse effects: insomnia, nervousness, anxiety, depression, blurred vision Orlistat is a lipas inhibitor that reduces absorption of fat by 30%, Pts need to adapt a low-fat diet with 30% calories from fat. Pts should take a multivitamin ____ hours before/after to supplement fat-soluble vitamins that may not be absorbed well. Orlistat: lipase inhibitor (reduce absorption fat by 30%). Must adopt low-fat diet with 30% calories from fat. Take multivitamin (2 hrs before/after) to supplement fat-soluble vitamins that may not be absorbed well. Orlistat (Xenical) is OTC as 60mg TID w/ meals, do not use in children under___ years old Not approved for children 12yrs old This med results in the least amount of weight loss, how much? 2-3% body weight (7lbs/yr) Adverse effects of Orlistat include: fecal incontinence, oily rectal leakage, flatus, abd cramping, liver damage ( light colored stools, dark urine, fatigue, jaundice, anorexia) When is Olistat contraindicated? contraindicated in people with malabsorption syndrome or cholestasis What vitamin deficiency may occur and what lab do we need to monitor if they're on Coumadin? Monitor Coumadin (INR) as Vit. K deficiency may occur & intensify effect of Coumadin Lorcaserin (Belviq) reduces waist curcumference, fasting glucose, insulin, total cholesterol, LDL, & triglycerides. Adverse effects include: headache, URI, back pain, hypoglycemia ( in pts w/ DM) When is this Lorcaserin contradindicated? CrCl ______, not approved _____ CrCl (creatintine Clearance) CrCL30 and is not approved in children. What are some potential drug interactions of Lorcaserin? Drug interactions include: MAOI inhibitors, SSIRs, SNRIs, etc. that increase risk for serotonin syndrome. What is the black box warnings of Naltrexone/Bupropion? Naltrexone & Bupropion hace black box warnings for: increased suicidal ideation & suicide attempts in children, adolescents, & young adults What are some drug-drug interaction of Naltrexone & Bubpropion? Do not take within two weeks of taking a MAOI. Opiod antagonist, so this will reduce effects of opiods. What conditions are Naltrexone & Bubpropion contraindicated in? Contraindicated in HTN, seizure disorders, eating disorders, alcohol or drug withdrawal. Not a controlled drug. Liraglutide (Victoza) is a GLP-1 agonst, how does it promote weight loss? Liraglutide (Victoza) promotes wt loss by slowing gastric emptying (increases satiety) Not approved in children. Liraglutide (Victoza) can cause baseline HR to increase by how much? Monitor for tachycardia not unusual for baseline HR to increase 10-20bpm In diabetic pts taking Liraglutide (Victoza) what do you need to watch for? hypoglycemia What baseline labs are needed when prescribing Liraglutide (Victoza)? Baseline labs include: lipds, CMP, HgbA1C Q6mo, triglycerides What is the black box warning for Liraglutide (Victoza)? black box warning: -contraindicated in multiple endocrine neoplasia syndrome type 2 - personal/family histjory of medullary thyroid carcinoma not a controlled drug According to the American College of Sports Medicine, people trying to lose weight should exercise at least ____ minutes/week (preferably more) 150minutes per week At what BMI is a person considered for bariatric surgery? Bariatric surgery is to be considered for BMI of 35 of more What are the two most common options for bariatric surgery? -Gastric Bypass Surgery (Roux-en-Y procedure) -Laparoscopic implantation of an adjustable band What is typical weight loss for those who diligently adhere to medication & lifestyle therapy? ___ % whereas ____% is exceptional A weight loos for 10% -15% is typical for those who diligently adhere to medication and lifestyle therapy, whereas a loss greater than 15% is exceptional. Most weight loss occurs during the first ____ months of treatment As a rule, most weight loss occurs during the first 6mo of treatment. Stage 0 of Weight Loss Therapy: A BMI of 25 of more with no complications - lifestyle therapy -drug therapy to be considered if lifestyle therapy alone is ineffective Stage 1 of Weight Loss Therapy: A BMI of 25 or more in the presence of one or more mild to moderate complications amenable to moderate weight loss -lifestyle therapy -drug therapy to be considered if lifestyle therapy alone is ineffective or if BMI is 27 or more Stage 2 of Weight Loss Therapy: A BMI of 25 or more at least one complication requiring significant weight loss - Lifestyle therapy -drug therapy considered for BMI 25-26 -Drug therapy initiated at 27 or more -Bariatric surgery considered for BMI 35 or more Antibiotic Classes and examples of infectious disease drugs ß-Lactams : penicillins -Penicillin G, V -Nafcillin, oxacillin, dicloxacillin -ampicillin, amoxicillin -piperacillin -combo-amp/sulbactam(unasyn), amox/clav (augmentin), pip/taco (zosyn) B-lactation: cephalosporin -cephalexin (keflex) -cefoxitin (mefoxin) -cefotaxime (claforan) -cefepime (maxipime) -ceftaroline (teflaro) Fluoroquinolones -ciprofloxacin (cipro) -ofloxacin (floxin) -levofloxacin (levaquin) -moxifloxacin (avelox) Tetracyclines and Macrolides -tetracycline, doxycycline -erythromycin, azithromycin(zithromax), clarithromycin (Biaxin) Sulfonamides, Trimethoprim, and Nitrofurantoin -sulfadiazine, sulfamethoxazole(bactrim) -trimethoprim (primsol) -TMP/SMZ: trimethoprim/sulfamethoxazole -nitrofurantoin (macrodantin) Examples of cell wall synthesis inhibitors penicillin, cephalosporin, imipenem, vancomycin What are the considerations when choosing antibiotic therapy *The HOST -history of allergy, cross allergy or intolerance -preexisting conditions: HIV, cancer, autoimmune disorders, diabetes -renal/hepatic function-cr clearance -Age, pregnancy and lactation, recent antibiotic use, exposure history (wt based dosing for pediatric and geriatric population) *The SYNDROME or PRESENTING ILLNESS -what system is impacted -how aggressive the infection -consider non-bacterial causes -carefully examine clinical presentation of illness *The PATHOGEN -obtaining culture and sensitivity/resistance -how susceptibility is determined AST/Petri dish growth When prescribing macrolides what is the patient teaching Take with food to reduce G.I. disturbances Which antibiotic should have a culture done before therapy begins Vancomyosin, Carbapenem, Penicillin Which antibiotics do not require a culture prior to start of therapy Tetracyclines and macrolides Situations when PO or IV antibiotics should be prescribed critical or severe infections Iv Mild/moderate or a patients admitted for other diagnoses who have an infection PO When can IV antibiotics be switched to PO? WHen pt is stable Bactericides antibiotics Directly kill bacteria Examples include aminoglycosides Beta lactums, Fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin Bacteriostatic agents Inhibit bacterial proliferation while the hosts immune system does the killing Examples include Clindamycin, macrolides sulfonamides and tetracyclines Broad-spectrum antibiotic uses Target wider number of bacteria types Acts on both Graham negative and gram-positive organisms Commonly used for empiric therapy when the pathogen is unknown or infection with multiple types of bacteria and suspected commonly used for empiric therapy when the pathogen is unknown or infection with multiple types of bacteria and suspected Risks of using broad-spectrum antibiotics Disruption of normal flora and development of anabiotic resistance Narrow spectrum antibiotic uses Affective against a specific bacteria type used when infecting pathogens are known reduces risk of disruption of normal flora and reduce development of anabiotic resistance What is the preferred antibiotic narrow spectrum or broad-spectrum Narrow spectrum Conjunctivitis is most likely caused by which bacteria Staphylococcus or streptococcus tx polymyxin-trimethoprim opthalamic drops for 7-10 days What are the causative agent of community acquired pneumonia S. Pneumonia (gram +) mycoplasma pneumoniae (atypical pneumonia) Viruses H. Influenzaem staphlylococcus aureus Therapeutic trials class used for CAP Amoxicillin doxycycline macrolides Likely prescription for a CAP Amoxicillin PO for 7 to 10 days or azithromycin PO for five days Tx for severe CAP Beta-lactam and macrolide or fluroquinolone Likely prescription for severe CAP Ampicillin/sulbactam IV and azithromycin IV or levofloxacin IV x 5 days What bacteria causes complicated and uncomplicated UTIs E. coli Treatment for complicated UTI drug class: fluroquinolones Ciprofloxacin PO for 1-2 weeks Uncomplicated UTI treatment Trimethoprim-sulfamethoxazole (Bactrim) for 3 days or nitrofurantoin x 5days How is pathogen identified for antibiotic use? Culture With Sensitivity and resistance report How is susceptibility determined? AST/Petri dish growth Antibiotics that need therapeutic monitoring Vancomyosin and aminoglycosides Beta-lactams: penicillins Prescribed for common infections in primary and acute care settings bactericidal there are four classes of pcn narrow-spectrum-penicillinase sensitive-P G, P V narrow-spectrum-pcn resistant- nafcillin, oxacillin, dicloxacillin broad spectrum: amp amox extended spectrum : piperacillin pcn/beta-lactamase combo: amp/sulbactam(unashamed), amox/clavulanate (augmentin) Penicillins Pharmacodynamics Inhibits biosynthesis of peptidoglycan bacterial cell wall beta-lactam ring must be intact for antimicrobial action combo w beta-lactamase inhibitors to broaden their spectrum: clavulante, sulbactam, tazobactam When are fluoroquinolones used for CAP When antibiotic resistance is possible d/t recent (within 90 days) treatment with antimicrobial agent and specific comorbidities Antibiotics that should be avoided during pregnancy Fluoroquinolones and tetracyclines Antibiotics that should be avoided in elderly with a creatinine clearance less than 30 mL per minute Cipro and nitrofurantoin If a patient is on warfarin which anabiotic's should be avoided Macrolides Cipro trimethoprim/sulfamethozole Which anabiotic should be avoided when a penicillin allergy is present Penicillin anabiotic's and cephalosporin Which anabiotic can cause fatal CDIff Clindamycin Which anabiotic's are ototoxic Aminoglycosides Which antibiotic could cause blood dyscaria Trimethoprim Which anabiotic can cause flaccid paralysis and respiratory depression Aminoglycosides Which anabiotic should be taken with 8 to 10 glasses of water per day Sulfonamides Which anabiotic's should sun be avoided when taking Tetracyclines What patient education should be given regarding antibiotics Report any side effects Complete whole regimen Look for signs of allergies Report any diarrhea especially when taking clindamycin Which anabiotic's require a renal impairment dosing Cephalosporins except ceftriaxone Carbapenem Which antibiotic should not be given if the patient takes Valproate Imipenem Which antibiotic should be avoided if the patient has hearing impairment or if receiving ototoxic and nephrotoxic drugs Aminoglycosides Which antibiotic should not be given to children younger than eight years of age or pregnant women Tetracyclines Which antibiotic should not be given when a folate deficiency is present Trimethoprim Which antibiotic Should not be given to patience with alcoholism pregnancy or debilitation Trimethoprim Name for classes of beta-lactam penicillins Narrow spectrum penicillin sensitive Narrow spectrum penicillin resistance Broad-spectrum Extended spectrum Name two Narrow spectrum penicillin sensitive antibiotic Penicillin G and V Name two narrow spectrum penicillinase resistant antibiotic Nafcillin oxacillin dicloxacillin Name broad spectrum penicillins. Aminopenicillins (Ampicillin and Amoxicillin) Name an extended spectrum penicillins. Piperacillin What are the beta-lactam cephalosporins Cephalexin (keflex) Cefoxitin (mefoxin) Cefoxtaxime (claforan) Cefepime(Maxipime) Ceftaroline (teflaro) Name the fluoroquinolones Ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin Name tetracycline and macrolide antibiotics Tetracycline doxycycline Macrolides: erythromycin azithromycin Clarithromycin (biaxin) Name examples of sulfonamides trimethoprim in Nitrofurantoin Sulfonamides : sulfacliazine , sulfamethoxazole (Bactrim) Trimethoprim: Primsol Nitrofurantoin Macrodantin TMP/SMz trim/Sulfamethoxazole Which antibiotic should not be taken if a patient has a prolonged QT Macrolides The causative agent of CAP in Smokers and COPD pts is? Haemophilus influenza (gram -) Causative agent of CAP in pts w cystic fibrosis? Pseudomonas aeruginosa (gram -) What is the gold standard for diagnosis of CAP Chest xray First line tx or CAP that have no comorbidities or risk factors Amox, doxycycline, macrolides What are comorbidities that would suggest use of fluoroquinolones for CAP? DM, COPD, chronic heart, liver, or renal disease, alcoholism, malignancy, immunosuppressive condition or use of immunosuppressive drugs Most common cause a fatal CAP M. Pneumoniae C. Pneumoniae S. Pneumoniae Legionella sp. H. Influenzae 56 yo F presents to the clinic w/productive cough. CXR shows RLL infiltrates. What is the tx plan based on diagnosis? Amoxicillin plus azithromycin for CAP Macrolide use in pregnancy and childreN w CAP? Safe; used empirically Macrolides therapeutic goal and uses Tx of resp infections or infections caused by H. Pylori, disseminated mycobacterium, and an alternate to pcn when pcn allergy is present High risk patients when using macrolides Pt w prolonged QT How to evaluate therapeutic effects of macrolides Reduction in fever, pain, or inflammation How to minimize adverse effects when using macrolides Give w food, avoid in pt w prolonged QT Fluoroquinolones therapeutic goal Tx of fluroquinolone-sensitive infections What patients are contraindicated or at high risk of fluoroquinolone use MG, renal impairment, over age of 60, pt taking glucocorticoids How to minimize AE during fluoroquinolone use? Instruct pt to report signs of tendon injury and avoid prolonged sun exposure First drug of choice for treatment of corynebacterium diptheriae or alternative to pcn G allergy Erythromycin What narrow spectrum antibacterial drugs are used for gram positive cocci and bacilli? pcn G and V penicillinase-resistant pcns: oxacillin and nafcillin vancomycin erythromycin clindamycin What narrow spectrum antibacterial drugs are used for gram negative aerobes? Aminoglycosides: gentamicin and others cephalosporins (1st and 2nd generation) What narrow spectrum antibacterial drugs are used for myobacterium tuberculosis Isoniazid rifampin ethambutol pyrazinamide What broad spectrum antibiotic are used to tx gram positive cocci and gram negative bacilli Pcn: amp and others extended spectrum pcn: piperacillin and others cephalosporins (3rd generation) tetracyclines: tetracycline and others carbapenems: imipenem and others trimethoprim sulfonamides: sulfisoxazole and others fluroquinolones: ciproflaxacin and others What antiviral drugs are used to tx HIV infections RTI: zidovudine and others PI: ritonavir and others FI: enfuvirtide II: raltegravir CCR5 antagonists: maraviroc Antiviral drugs used to tx influenza Adamantanes: amantadine and others neurainidase inhibitors: oseltamivir and others Antifungal drugs Polymer antibiotics: amphotericin B and others Azoles: itraconazole and others echinocandins: caspofungin and others Antiviral drugs not used to tx influenza Acyclovir ribavirin interferon- Antimicrobial agents that inhibit cell wall synthesis penicillins, cephalosporins, imipenem, vancomycin, caspofungin Antimicrobial agents that disrupt the cell membrane Amphotericin B Daptomycin itraconazole Antimicrobial agents that inhibit protein synthesis (bactericidal) Aminoglycosides Antimicrobial agents that inhibit protein synthesis (bacteriostatic) Clindamycin erythromycin linezolid tetracycline Antimicrobial agents that interfere w synthesis or integrity of bacterial DNA and RNA Fluroquinolones metronidazole rifampin Antimicrobial agents that are antimetabolites Flucytosine sulfonamides trimethoprim Drugs that suppress viral replication through inhibiting DNA polymerase Acyclovir ganciclovir Antiviral drugs that target reverse transcriptase Zidovudine lamivudine Antiviral drugs that inhibit HIV protease Ritonavir saquinavir Antiviral drugs that inhibit HIV fusion Enfuvirtide Antiviral drugs that are CCR5 antagonsits Maraviroc Antiviral drug that inhibits influenza neuraminidase Oseltamivir zanamivir treatment of tinea corporis topical antifungals like AZOLE or allylamine Treatment of Tinea Cruris topical antifungals oral antifungals in extreme cases (clotrimazole) Topical or systemic glucocorticoids may be needed as well treatment of tinea capitis oral griseofulvin taken for 6 to 8 weeks Oral terbinafine taken 2 to 4 weeks may be more effective Oral Candidiasis (Thrush) Topical agents Nystatin, clotrimazole, and miconazole oral candidiasis tx in immunocompromised Oral therapy with fluconazole or ketoconazole Aspergillosis treatment Voriconazole You're a con is all in phenobarbital should not be combined due to CYP 450 Adverse reactions for itraconazole Cardiac suppression and liver toxicity because if it's negative inotropic actions it should not be used for superficial fungal infections in patients with heart failure history of heart failure or other indications of ventricular dysfunction Baseline data and Monitoring needed while using azoles Liver function ASTALT alkaline phosphate bilirubin prior and monthly 3-4 months Patient teaching for adverse reactions for Itraconazole Negative inotropic actions bradycardia Should not be used for superficial Fungal infections in patients with heart failure history of heart failure or indications of ventricular dysfunction Patient teaching for a nucleotide reverse transcriptase inhibitors Lactic acidosis severe hepatomegaly with steatosis NRTIs Abacavir (ziagen) Didanosine (videx) Emtricitabine Lamivudine Stavudine Tenofovir Zidovudine Patient teaching for azoles Instruct patient to report signs of liver dysfunction and avoid drugs metabolized by CYP3A4 (warfarin cyclosporine digoxin quinidine) Nystatin life stage info Safe to treat oral candidiasis in premature and full-term infants Fluconazole safe to treat systemic candidiasis in newborn infants Safe in children in lower doses Risk versus benefit considered during pregnancy Low doses for breast-feeding women except Ketoconazole hi potential for hepatotoxicity Older adults high risk for aCHLORHYDRIA — What are helminths And how are they treated parasitic worms Anthelmintics Anthelmintic Monitoring Albendazole liver function and CBC with diff Mebendazole Liver function CBC with diff and renal function Praziquantel liver function Ivermectin and moxidectin Ophthalmological exam if abnormal at baseline Stool sample one to three weeks for proof of cure Therapeutical for HIV treatment Maximal and long lasting suppression of viral load Restoration and preservation of immune function Improve quality of life Reduction of HIV related morbidity and mortality Prevention of HIV transmission Baseline data needed when prescribing HIV medication Complete history and physical exam CD4 count HIV viral load resistance testing HBsAb HBsAg HBcAb total HCV antibody serum Na K HCO3 Cl BUN Cr GFr ALT AST total Bilirubin CBC with diff fasting lipid profile fasting glucose urinalysis pregnancy test Name anthelmintics Ivermectin Albendazole Moxidectin Pyrantelpamoate Mebendazole Identify high-risk patients when using albendazole Bone marrow suppression impaired liver function and renal function Patients with liver kidney anemia bleeding disorders and infections are at increased risk Identify high-risk patients when using praziquantel Patients with cardiac disease liver impairment or seizure disorders are increased risk for complications How should we be prescribing Medications That decrease gastric acid? At least two hours apart from other drugs due to decreased drug absorption Liver impairment and bone marrow function Adverse effects when taking parental pamoate In neonate it can cause potentially fatal gasping syndrome Adverse effects when taking mebendazole Bone marrow suppression and liver impairment Adverse effects one taking ivermectin Pruritis Rash fever lymph node tenderness and bone and joint pain Known as Mazzotti reaction Adverse effects when taking moxidectin Flu like symptoms of the Mazzotti response Associated with death of the microfilariae failure during the first week Which anthelmintic is safe during pregnancy Praziquantel Treatment of Glaucoma Timolol Parasympathomimetics (mimics parasympathetic- rest/relaxation syndrome): Pilocarpine: this drug enhances papillary constriction they are myotic drops. Adverse reactions: Bronchospasm. N/V, diarrhea. Blurred vision, twitching eyelids, eye pain with focusing. Nursing Implications: Use cautiously with pregnancy, asthma, hypertension. Teach proper drop instillation technique. Need for ongoing use of the drug at precribed intervals.** Blurred vision tends to decrease with regular use of this drug.** Beta-Adrenergic Receptor Blocking Agents: Timolol/ Carteolol: Inhibits formation of aqueous humor. Adverse Reactions: Side effects are insignificant. Hypotension. Nursing Implications: use cautiously with- hypersensitivity, Asthma, Second or third-degree heart block, HF, Congenital glaucoma, Pregnancy. Teach proper drop instillation technique. Need for ongoing use of the drug at prescribed intervals. Blurred vision tends to decrease with regular use of this drug. Carbonic Anhydrase Inhibitors: Diamox-PO: reduces aqueous humor production. Adverse Reactions: numbness, tingling of hands and feet. Nausea and Malaise. Nursing Implications: Administer orally or IV. Produces diuresis. Assess for metabolic acidosis. Prostaglandin Antagonists: Lumigan: lowers IOP of gluacoma by increasing outflow of aqueous humor. Adverse Reactions: Local irritation. Foreign-body sensation. Increased brown pigmentation of iris. Increased eyelash growth. Treatment of glaucoma with someone who has asthma or COPD Identify patients that would be at high risk when using Ivermectin and Moxidectin Patients with hypertension or taking anti-hypertensive drugs may be at risk for increased hypotension and falls Identify high-risk patients using mebendazole Bc Bone marrow suppression and liver impairment may occur, Patience with liver disease anemia bleeding disorders and infections are at increased risk High-risk patients using pyrantel pamoate Patients with liver impairment are at a higher risk for adverse effects Neonate's should not be prescribed formulations containing benzyl alcohol or it's derivatives Which beta blocker is beta1 selective and preferred for patients with asthma or COPD Betaxolol treatment for Otis media Penicillin (class) Amoxicillin or Augmentin Treatment of otitis externa Ciprofloxacin/DexaMethasone drops ofloxacin drops Treatment of mild acne Benzyl peroxide or retinoid Treatment of Moderat acne Topical combo or oral antibiotics plus retinoid plus benzyl Oral anabiotic's plus topical combo or Isotrentinoin treatment of severe acne Oral anabiotic plus topical combo or isotretinoin First line therapy for eczema Moisturizers and topical glucocorticoids (Cetaphil moisturizing cream Eucerin original cream) Mild to moderate treatment of eczema Primecrolimus (Elidel) 1% cream is a topical immunosuppressant approved for mild to moderate a topic dermatitis Moderate to severe treatment of eczema Tacrolimus (Protopic) Is available as an appointment for a moderate to severe a topic dermatitis Patient risk when taking tacrolimus Skin cancer and lymphoma to reduce risk Protect treated areas from direct sunlight Sunlamps and tanning beds Most common side effects of eczema OK Burning itching stinging at site Adverse effects of montelukast Nuro psychiatric effects including agitation aggression hallucinations depression insomnia restlessness and suicidal thinking of behavior Is montelukast more or less effective than intranasal glucocorticoids Less effective Potential adverse effects of intranasal glucocorticoids Nasal drying of the mucosa and burning or itching sensation sore throat epistaxis headache possible slowing of linear girls and children What is the most effective drugs for prevention and treatment of seasonal and perennial rhinitis Intranasal glucocorticoids What should we teach your patience when prescribing intranasal glucocorticoids They should be used daily rather than irregularly full dose is given initially and then after symptoms are under control dose is reduced to lowest effective amount maximal effects require a week or more to develop Potential adverse effects of sympathomimetics? Oral: restlessness, insomnia, increased blood pressure nasal: rebound nasal congestion Which sympathomimetic is associated with abuse Pseudoephedrine Potential serious adverse effects of phenylphrine Adverse cardiovascular and CNS affects Do antihistamines relieve nasal congestion? No Most common adverse effects of Brimonidine Dry mouth ocular hyperemia local burning stinging and headache blurred vision foreign body sensation and itching Potential adverse effects of prostaglandin analogs Heightened brown pigmentation of the iris and eyelid and blurred vision burning stinging conjunctival edema, punctate keratopathy lantanoprost may cause macular edema What is an example of a prostaglandin analog Latanaprost travoprost (travatan), bimatoprost (lumigan) latanoprostene bound, and tafluprost (zioptan) What education should we provide to patients regarding the use of salicylic acid Rare systemic salicylate toxicity (salicylism) can result when large amounts are used for a prolonged period symptoms of salicylism include tinnitus, hypercapnea and psychological disturbances system effects can be minimized by avoiding prolonged use of high concentrations over large areas make sure you clean and dry face before use Potential adverse effects of benzoyl peroxide Iritation(burning, blistering, scaling swelling) the freq of application should be reduced potential hypersensitivity reactions especially in patients w asthma What is the black box warning for isotretinon? High risk of severe structural and cognitive defects in the developing fetus. Increased risk for spontaneous abortion use 2 contraceptives while using Avoid driving at night protect from sun return for periodic blood tests What symptoms does loratadine control Sneezing, rhinorrhea, nasal itching How do we manage rebound congestion D/c drug in one nostril at a time or use intranasal glucocorticoid (in both nostrils) for 2-6 weeks starting 1 week before d/c of decongestant What is the role of biological such as Omalizumab in treating allergies Monoclonal antibody directed against IgE an immunoglobulin that plays a central role in allergic release of inflammatory mediators from mast cells and basophils patients w ragweed induced seasonal allergic rhinitis have achieved symptom relief w omalizumab when other drugs have been ineffective, this drug is prescribed for off label use Monitoring of phentermine/topiramate baseline chem, electrolyte serum creatinine s/s acidosis s/s depression What are adverse effects and patient teaching for orlistat GI effects oily rectal leakage, flatulence w discharge, fecal urgency, and fatty or oily stools or severe liver damage s/s are itching, vomiting jaundice, anorexia, fatigue dark urine and light colored stools REPORT IMMEDIATely Reduce fat intake to prevent GI effects Drug interactions when taking orlistat Levothyroxine Ongoing assessment needed when taking orlistat S/s deficiency in fat soluble vitamins A, D, E, and K vit K deficiency effects on warfarin Adverse effects for Lorcaserin Headache, back pain, decrease in lymphocytes and URI Pt w DM can experience increase in hypoglycemic events less common but serious include blood dry arias, cognitive impairment, psychiatric disorders, priapism, pulmonary hypertension and valvular HD Possible Drug interactions when using lorcaserin Bupropion, dextromethorphan, MAO inhibitors, SNRIs, SSRIs, St. John's wort and triptans Baseline assessment before prescribing lorcaserin R/o valvular HD and pulm HTN What ongoing monitoring is needed when taking lorcaserin Cognitive changes, CBC w diff, s/s of blood dyscarias Baseline data needed before prescribing Liraglutide Pt or family ability administer injections HbA1C q 6m if stable more often if not, periodic triglyceride monitoring if needed, assess for s/s of cholecystitis pancreatitis depression and suicidal thoughts Pt teaching for naltrexone/bupropion Can precipitate opioid w/d warn pt about liver injury and advise them to d/c if s/s hepatitis develop Adverse effects of naltrexone/bupropion N, V, HA, dizziness, insomnia increase BP dry mouth diarrhea abd discomfort anx fatigue risk of suicide Baseline data before prescribing naltrexone/bupropion Liver function, blood glucose, renal function and mental status Periodic assessment for naltrexone/bupropion Blood glucose, live/renal function, s/s depression or panic attacks, suicidal ideation and mania Baseline data and ongoing assessment when prescribing phentermine BL: cardiac assessment Ongoing cardiac assessment What is the role of topiramate in tx of obesity Induces sense of satiety BMI Weight (kg)/m2 [Weight in lbs / height inches^2] * 703 BMI when underweight Less than 18.5 BMI when normal weight 18.5-24.9 BMI when overweight 25-29.9 BMI when obese 30-39.9 BMI when morbidly obese 40 and greater treatment for stage 0 BMI 25 or more w no complications DEA schedules of drugs used to treat obesity IV, III Pathogen most likely to cause blepharitis Staphlylococcus doxycycline PO x 1 month Likely pathogen to cause contact lens conjunctivitis Psuedomonas besifloxacin opthalamic drops 7-10 days Most likely pathogen to cause hordeolum (stye) and what tx is used S. Aureus, MRSA bacitracin ointment 5-7 days Most common pathogen seen in tobacco related lung disease H. Influenzae Most common pathogen that is transmitted through cough and seen in ppl who spent extended period of time in proximity of correctional facilities, college dormitories, and LT care facilities? C. Pneumoniae and M. Pneumoniae Systemic Opportunistic fungal infections pathogens Candidiasis, Aspergillosis, cryptococcus, mucormycosis Tx for systemic fungal infection Amphotericin B (BS, highly toxic, IV only, premed w acetaminophen and diphenhydramine) Azoles (BS, inhibits CYP450, IV or PO) ex: ketaconazole (CI: prolonged QT, AR: hepatic necrosis), fluconazole (diflucan)