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Maryville NURS615 Pharm 2 Exam - Questions With
Efficient Solutions
Monitoring Parameters for antivirals such as acyclovir(Zovirax)/valacyclovir(Valtrex)? Right Ans - 10% liver/90% kidney = BUN, Creat, LFT What is the Class and MOA of carbamazepine (tegretal) & topiramate (Topamax)? Right Ans - Anticonvulsant; thought to block Na+ channels to slow activity or enhance GABA Adverse effects of Carbamazepine and monitoring parameters Right Ans - Agranulocytosis: decreased production of WBC in bone marrow, SJS, Toxic Epidermal Necrolysis; Monitor CBC Q 3-4 mos; TSH (can also affect thyroid) What precautions should be taken when discontinuing Carbamazepine? Right Ans - Do Not stop abruptly; half life drops from 30 hr to 15 over time What is GABA? Right Ans - calming/inhibitory neurotransmitter; calms firing nerves in CNS; high levels improve focus, low levels cause anxiety What is serotonin? Right Ans - mood neurotransmitter; Affects mood, hunger, sleep, and arousal What is norepinephrine/noradrenaline? Right Ans - Concentration neurotransmitter; affects attention and responding actions; fight or flight What is dopamine? Right Ans - pleasure neurotransmitter; feelings of pleasure, addiction, motivation What is acetylcholine? Right Ans - parasympathetic neurotransmitter that diffuses across a synapse and produces an impulse in the cell membrane of a muscle cell What should families be taught regarding the monitoring of seizure activity? Right Ans - focus on prevention, pt safety, quality of life; if seizure occurs notefrequency, duration, severity; be aware of mood changes, depression,
anxiety, suicide; establish mutual treatment goals, DO NOT stop meds abruptly What electrolyte imbalance is noted with Topiramate (Topamax) & what to monitor? Right Ans - a decrease in serum bicarbonate concentration, leading to hyperchloremic metabolic acidosis; CMP & bicarb Adverse effects seen with topiramate (Topamax) and pregnancy risk? Right Ans - ocular syndromes (myopia and angle closure glaucoma), ↓sweating (oligohidrosis), hyperthermia; in pregnancy: ↑risk of cleft lip in infants What is the MOA for Levetiracetam (Keppra) Right Ans - Does not affect GABA; may prevent epileptiform burst firing and spread of seizure activity. What population is Levetiracetam (Keppra) safer for? Right Ans - Children and pregnancy What are the pregnancy precautions for valproate (Depakote) Right Ans - Cat X; known teratogen; if necessary take after 1st trimester Education for women taking valproate (Depakote) wanting to get pregnant? Right Ans - possibility of birth defects, switch meds, be followed by high-risk OB What should be monitored commonly with all anticonvulsants? Right Ans - their levels What are the precautions and contraindications for the tricyclic antidepressants (TCA)? Right Ans - Cardiac conduction disorder causing prolonged QT, get base ECG; sever tardive dyskinesia and/or neuroleptic malignant syndrome; OD suicide; Anticholenergic=dry mouth, constipation, urinary retention 2 important things to be aware of with SSRIs Right Ans - Serotonin syndrome, withdrawal syndrome
What can happen if foods containing tyramine (aged cheese/meats, alcohol) are consumed while on MAOI Right Ans - hypertensive crisis Before starting a different med how long should it be after weaning off MAOI? Right Ans - at least 2 wks What are the main side effects of SNRIs & NRIs Right Ans - headache, somnolence, nausea, (dry mouth, constipation=anticholinergic effcts), sexual side effects, palpitations, hyperhidrosis, hypertension What is the MOA for benzodiazapine? Right Ans - binds to GABA receptors to inhibit the neurotransmitter release; ↑ action of GABA, ↓ neuronal excitment (CNS depression) What can occur if Benzo use is combined with ETOH or other CNS depressants? Right Ans - Sedative effects How should benzos be discontinued? Right Ans - wean off; potential for withdrawal sx What is the MOA with Buspirone (Buspar)? Right Ans - full agonist for presynaptic, partial agonist for postsynaptic; if too much serotonin=antagonist; if too little serotonin=agonist What receptors do the antidepressants and antianxiety medications act on Right Ans - SSRI (↑ Serotonin), SNRI & TCA (↑ serotonin/Norepi), MAOI ( ↑ serotonin/Norepi/dopamine), Anxiolytic; Benzos ( (↑ GABA, ↓ neuronal excitation: ↑ FREQ of opening CL- channel=CNS depression) What class is zolidem (Ambien) and what is the MOA? Right Ans - nonbenzodiazepine hypnotic; acts at the GABA receptor but not benzo site What class is temazapam and the MOA? Right Ans - Benzodiazepine that treats insomnia; (↑ GABA, ↓ neuronal excitation). What does healthy sleep hygiene refer too? Right Ans - interventions that increase the quality of sleep
how should insomnia med be prescribed? Right Ans - only for short period of time while pt develops good sleep habits and patterns What factors will place the patient at risk for antibiotic resistance? Right Ans - bacteria genetic mutation, elder, infants, pt noncompliance, immunocompromised What factors place the patient at risk for hypersensitivity reactions with penicillins and cephalosporins? Right Ans - there is a cross sensitivity reaction due to the fact that each class contains a bata lactam ring What are the safest antibiotics to prescribe to a woman who is pregnant and which ones should be avoided? Right Ans - Penicillins, & cephlasporins; avoid tetracycline & quinolones what factors can cause/exacerbate resistance to antibiotics? Right Ans - Inactivation of drug (beta-lactamase), altered target (change binding sites), reduced influx, and Increased efflux Which antibiotics inhibit bacterial cell wall synthesis? Right Ans - bactericidal; beta-lactams; penicillin, cephalosporin, carbapenems, monbactams Why is clavulanate added to Amoxicillin? Right Ans - it is a beta-lactamase inhibitory; gram-neg have ↑ B-L so enhances antibx ability to attack What antibiotics are appropriate to prescribe to children? Right Ans - Penicillins, cephalosporin, erythromycin Which antibiotics block bacterial protein production? Right Ans - bacteriostatic; Macrolides (erythromycin), Tetracyclines, Lincosamides (Clindamycin), Rifampin, Ototoxicity and nephrotoxicity associated with this antibiotic: Right Ans - Aminoglycosides;GNATS gentamicin, neomycin, amikacin, tobramycin, streptomycin Alternative antimicrobial drug(s) for treating penicillin-resistant S. aureus: Right Ans - vancomycin & methacillin
A patient is administered gentamicin and complains of sudden hearing loss. What should the nurse practitioner do? Right Ans - aminoglycoside; stop immediately; ototoxic; irreversible hearing loss Which medications interact with linezolid (Zyvox)(used for Hosp MRSA)? Right Ans - MAOIs, SSRIs - increased risk of serotonin syndrome, avoid foods containing tyramine (aged - can cause hypertensive crisis), OTC-cold meds What is the course of treatment with doxycycline for the treatment of Lyme Disease? Right Ans - 100mg twice daily for 14-21 days What are the main side effects of doxycycline? Right Ans - GI upset (take with food), photosensitivity, developing C. diff Differentiate between oral and parenteral vancomycin Right Ans - IV because it is largely hydrophilic and to big to pass through the cell wall in the GI; orally as 'topical' for C. diff What is the mechanism of action of azithromycin Right Ans - Macrolide; blocks protein synthesis What vitamin will decrease peripheral neuropathy? Right Ans - You often see this in patients on isoniazid therapy for tuberculosis. The treatment is pyridoxine (Vit B6) What lab values should be assessed when administering valacyclovir (Valtrex)? Right Ans - metabolized 10% liver 90% kidney; BUN & Creat; LFT If the client with strep pharyngitis is allergic to PCN or Cephalosporins...then what? Right Ans - azithromycin (Z-pak) When should oseltamivir phosphate be prescribed? Right Ans - (Tamiflu), within 48 hrs of flu sx onset For what is rifampin prescribed? Right Ans - (antimycobacterial); TB, leprosy, and legionella. It often is used with other antibiotics; prophylaxis to H. influenza and meningococcal
What is isoniazid used for? Right Ans - First-line therapy for prevention and treatment of latent and active TB What are the adverse effects of isoniazid (INH)? Right Ans - Peripheral neuropathy; take Pyridoxine (vitamin B6) with it When is prophylactic oseltamivir recommended? Right Ans - only in high risk pt within 48 hr exposure to flu; long-term care facility during outbreak, immunosurrpressed When prescribing ketoconazole, how should it be administered? Right Ans
- orally or topicall; orally can be hepatoxic monitor LFTs What is hypochlorhydria? Right Ans - a state where the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low. what to advise pt If needs to take H2 blockers while on antifungal and has hypochlorhydria? Right Ans - take with acidic drink (OJ) antifungals need ↑ acid enviro What lab values should be monitored when administering antifungal agents? Right Ans - S/E hepatoxicity; LFTs (AST, ALT, Bili) What antifungal medications can be used to treat topical candidiasis infections? Right Ans - clotrimazole, nystatin, mycostatin What are the main side effects of ethambutol? Right Ans - Used in TB; optical neuritis, irreversible blindness, red and green color blindness What medication is used to treat scabies? Right Ans - permethrin cream; ivermectin off-label for immunocomprimised What are the side effects of rifampin? Right Ans - causes red/orange body secretions; warn that will stain contacts; Hepatotoxicity What are monitoring parameters for Antivirals, such as acyclovir/valacycovir? Right Ans - can be nephrotoxic; BUN/Creatinine
What patients should avoid TCAs and why? Right Ans - Cardiovascular patients; causes prolong QT intervals & pts with BPH or glaucoma due to urinary retention What antibiotics do we prescribe in burn patients Right Ans - Sulfonamides drugs (silver sulfadiazine, Sulfamethoxasole) What antibiotic inhibits folic acid synthesis? Right Ans - Sulfonamides What class of antidepressants has the most anticholinergic side effects? Right Ans - TCA; avoid use in pts with BPH, glaucoma, GI dx Which Beta-lactams would experience a cross allergy and why? Right Ans - Cephalosporin's and Penicillins; because they both contain a beta-lactam ring vulnerable to beta-lactamase-producing organisms major adverse effect of clindamycin Right Ans - C. diff Griseofulvin is used to treat what? how should it be taken Right Ans - ringworm; with a fatty meal What medications are used to treat depression in children? Right Ans - Fluoxetine and citalopram are the only FDA approved treatment of depression for those ages 8- what meds inhibit folic acid production and How to manage or treat adverse events related to folic acid metabolite medications? Right Ans - Sulfonamides/Trimethoprim drugs impede folic acid production; prescribing folic acid, stopping Bactrim (sulfa+trimeth), increasing folate rich diet (leafy greens, citrus, beans, whole grains). What is Fluoxitine? Right Ans - SSRI and also called Prozac What are atypical antipsychotics and how are they used? Right Ans - second-generation antipsychotic medications; have reduced EPS- extrapyramidal symptoms (Dystonia/tardive dyskinesia; Schizophrenia (hallucinations/delusions), MDD, Bipolar
What is the treatment for intestinal parasitic worms Right Ans - Anthelmintic; mebendazole and agromectin What drug class has a cross resistance with macrolides Right Ans - Lincosamides: share the same ribosomal binding sites True or false: every single class of antibiotics has resistant organisms Right Ans - True What is Ethosuximide (Zarontin) used for and what should be monitored? Right Ans - absence seizures. Can cause blood dyscrasias. Monitor CBC and liver What is Phentermine (Adipex-P) and what drugs should be avoided when taking it? Right Ans - short-term use for obesity; avoid SSRIs & St Johns Wort (seratonin syndrome) & MAOI (HTN crisis) What class of medication can cause lupus/hepatitis, fatty liver, tinnitus, SJS? Right Ans - Tetracyclines Your patient has a ventral septal defect but no other cardiac issues is an antibiotic prophylaxis required? Right Ans - NO; only those with prosthetic heart valves, previous infective endocarditis, congenital heart disease, heart transplant with valve regurgitation What antidepressants should not be prescribed in those with seizure disorder? Right Ans - Fluoxitine (long half-life) & use TCAs with caution (lowers seizure threshold)
