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Advanced Pharmacology NR 565 Final Exam Questions with Answers 2024 FINAL EXAM SOLUTION Advanced Pharmacology NR 565 Final Exam Questions with Answers 2024 FINAL EXAM SOLUTION
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Who should receive Tdap vaccination? - SOLUTION Adults in close contact with infants healthcare workers Contraindication for Tdap vaccine - SOLUTION Severe allergic reaction to previous dose, or hx of encephalopathy within 7 days of vaccine Varicella vaccine contraindications - SOLUTION Hx of anaphylaxis with previous dose, allergy to gelatin or neomycin Hepatitis B vaccine contraindications - SOLUTION Previous rxn to vaccine, allergy to yeast and neomycin Examples of attenuated vaccines - SOLUTION measles, mumps, rubella, chickenpox, yellow fever, rotavirus examples of live vaccines - SOLUTION MMR, varicella, rotavirus, influenza examples of toxoid vaccines - SOLUTION Diphtheria, tetanus, pertussis, Examples of inactive viral antigen vaccine - SOLUTION Poliovirus (SALK), Hep A, Hep B, influenza What are the types of immunity? - SOLUTION active, passive, and herd Define vaccine - SOLUTION suspension of organisms or fractions of organisms that induce immunity Post exposure prophylaxis for Rabies - SOLUTION human rabies immunoglobulin + human diploid cell vaccine on days 0,3,7, Patient teaching after vaccination - SOLUTION Redness and swelling can occur at site, mild fever or fatigue
Who can receive attenuated influenza vaccine (Flumist) - SOLUTION individuals >2yo an d less than 50. non pregnant, and those who are not immunocompromised Pantoprazole dosing - SOLUTION 40 - 80 mg ORAL or IV Qday Metronidazole (Flagyl) dosing - SOLUTION 250 mg 4x day or 500mg BID for 7-14 days Ondansetron (Zofran) dosing - SOLUTION -8/24mg po 30 minutes prior to chemo initiation -8/16 mg po Q12h for 1/2 days after chemo administration -TOP 200 Albuterol Sulfate (inhalation) dosage - SOLUTION 2 inhalations What labs are used to diagnose thyroid disease - SOLUTION TSH T3 T When should you recheck labs after starting levothyroxine - SOLUTION 6- weeks until euthyroid state signs and symptoms of hypothyroidism - SOLUTION Thin, dry hair Thick, brittle nails constipation bradycardia Goiter PeriOrbital edema cold intolerance weight gain signs and symptoms hyperthyroidism - SOLUTION 1. heat intolerance (high heat production)
Treatment of thyroid storm - SOLUTION - Propylthiouracil (preferred) or methimazole
Diabetic ketoacidosis Hypersensitivity Clinical evidence of active liver disease Active bladder cancer Diabetic drug classifications - SOLUTION GLP- TZD DPP-4i Sulfonylureas SGLT2i Which drug class should be considered for diabetes prior to insulin - SOLUTION It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated. Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin - SOLUTION Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD) Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting. Carbohydrate to insulin ratio when calculating basal insulin - SOLUTION 500 divided by TDD Which diabetic medications come with concern of hypoglycemia - SOLUTION Insulin, meglitinides, sulfonylureas, amylin analogues Who is at risk for Methylxanthines toxicity - SOLUTION Older Adults taking anticholinergics and beta agonists Smokers Step 1 therapy for asthma and COPD - SOLUTION Manage with a SABA (albuterol) as needed. Asthma Step 1: Intermittent - SOLUTION SABA PRN Asthma Step 2: Mild Persistent - SOLUTION -General Symptoms > times/week BUT <1 time/day; exacerbations may affect activity
-Night Symptoms >2 times/month -Lung Function: FEV1 or PEF ≥80% predicted. PEF variability 20-30% Asthma Step 3: Moderate Persistent - SOLUTION -General Symptoms: Daily symptoms. Daily use of inhaled SABA. Exacerbations ≥2 times/week; may last days. -Night symptoms >1 time/week -Lung Function: FEV1 or PEF >60% to <80% predicted. PEF variability
30% Asthma Step 4: Severe Persistent - SOLUTION -General Symptoms: Continued symptoms. Limited physical activity. Frequent exacerbations. -Night Symptoms: Frequent -Lung Function: FEV1 or PEF <60% predicted. PEF variability >30% SABAs - SOLUTION albuterol, levalbuterol, terbutaline Benefits of SABA - SOLUTION Short acting relief of bronchospasm Relieves asthma attacks SABA patient teaching - SOLUTION Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed. Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and clean the mouthpiece with water at least once a week. Instruct patient to notify health care professional if there is no response to the usual dose or if contents of one canister are used in less than 2 wk. Asthma and treatment regimen should be re-evaluated and corticosteroids should be considered. Need for increased use to treat symptoms indicates decrease in asthma control and need to re-evaluate patient's therapy. Importance of knowing how often to use SABA - SOLUTION Can be deadly if misuse LABAs - SOLUTION Salmeterol Formoterol Oldaterol
Benefits to a LABA are? - SOLUTION Less frequent dosing and nocturnal protection LABA use in COPD - SOLUTION Usually first line in combination with LAMA Examples of inhaled corticosteroids - SOLUTION beclomethasone, budesonide, fluticasone Benefits of inhaled corticosteroids - SOLUTION Decrease eosinophils/mast cells/T-lymphocytes Inhibit transcription of inflammatory genes in airway epithelium Reduce endothelial cell leak Upregulate B2 receptor production Reduce airway epithelial subbasement membrane thickening Steroid use in asthma - SOLUTION Short course of oral when asthma attack occurs usually prednisone When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor) - SOLUTION Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations. How does nicotine work? - SOLUTION when it gets into the brain, it attaches to acetylcholine receptors and mimics the actions acetylcholine. It also activates areas of the brain that are involved in producing feelings and pleasure and reward. Nicotine Replacement Therapy (NRT) - SOLUTION a form of medicine that delivers small amounts of nicotine to the body to help a person quit using tobacco Nicotine replacement education - SOLUTION inhalers should not be used by clients with asthma, with the gum and loengers no eating or drinking 15 minutes prior to using and during, with the patch take off at night because can cause nightmares or sleep disturbances and teach patient not to use other nicotine products while using patch due to the stimulation of the CNS, the lozenges need to slowly dissolve for effectiveness and no more then 5 in a 6 hrs period
Wellbutrin Contraindications - SOLUTION caution in patients with a history of seizures, anorexia nervosa, cocaine use, and alcohol withdrawal and bupropion. SR should not be given with MAOI inhibitors Bupropion (Wellbutrin) length of treatment - SOLUTION 7-12 weeks Drug resistant TB - SOLUTION resistant to at least one first-line anti-TB drug Treatment of TB in pregnancy - SOLUTION 2 mos: INH, RIF, EMB 7 mos: INH, RIF Isoniazid (INH) - SOLUTION -antiTB
How to treat moderate to severe GERD - SOLUTION Long-term maintenance therapy of PPI is recommended for severe. Moderate??? GERD treatment in older adults - SOLUTION Avoid long term PPI due to associated bone fracture and vitamin and mineral deficiency Which cytoprotective agents can be given in pregnancy - SOLUTION Carafate When to test for H. pylori - SOLUTION If on treatment and not getting better. Consider testing before prescribing H2 receptor antagonists/PPIs. how to treat H. pylori - SOLUTION 2 antibiotics, PPI, pepto. MOC. AOC Lifestyle modification to support ulcer healing - SOLUTION 5-6 small meals a day, stop smoking, avoid NSAIDs Which antidiarrheal agent should not be used in children during or after chickenpox - SOLUTION Pepto-Bismol (Bismuth Subsalycitate) Traveler's diarrhea - SOLUTION E. coli Traveler's Diarrhea Treatment - SOLUTION Cipro Ciproflaxin (Cipro) teaching in Travelers Diarrhea - SOLUTION Only start if symptoms are progressive and not getting better with pepto What drug is associated with gray/black stool and black tongue - SOLUTION Pepto-Bismol (Bismouth Subsalicylate) constipation lifestyle changes - SOLUTION regular exercise increase fluids!!! bowel habit training Increase fiber Risks of laxatives during pregnancy - SOLUTION Gastrointestinal stimulation can induce labor. Constipation treatment in pregnancy - SOLUTION Lifestyle -Try fiber (psyllium, methyl cellulose) with adequate fluids first
-docusate and PEG are used to prevent and treat Constipation treatment in breastfeeding - SOLUTION Senna How does psyllium work? - SOLUTION absorbs H2O into GI tract to increase bulk of stool What happens when psyllium doesn't produce bowel movements - SOLUTION Can result in fecal impaction and obstruction Abd pain should be assessed with no BM Why is a diary important in treatment and diagnosis of IBS - SOLUTION Can identify triggers how to treat gastroparesis - SOLUTION Prokinetic drug is best Reglan black box warning reglan - SOLUTION tardive dyskinesia Metronidazole education - SOLUTION -avoid ETOH during and 2 days after -take on empty stomach -dry mouth