NR 565 Midterm Exam.pdf, Exams of Nursing

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NR 565 Midterm Exam

What are medication examples of Schedule II drugs? - CORRECT ANSWERS--Ativan & Valium

• Fentanyl
• Oxycodone
• Methadone What medications are Schedule III drugs? - CORRECT ANSWERS--Xanax
• Tramadol
• anabolic steroids
• <90mg of codeine What medications are Schedule IV drugs? - CORRECT ANSWERS--Ativan
• Tramadol
• Methadone
• Adderall Which schedule drugs can APRNs prescribe? - CORRECT ANSWERS-Schedule II through Schedule IV examples of reasons for medication non-adherence - CORRECT ANSWERS--too busy
• too expensive
• ran out
• forgetting
• traveling & busy Distribution in medication in elderly can be affected in what ways? - CORRECT ANSWERS--decreased lean mass
• decreased albumin
• decreased body fat
• slower gastric acidity
• slower absorption results in delayed response In the elderly decrease albumin and decreased lean mass affects medications how? - CORRECT ANSWERS-medication binds to protein so decreased protein affects how medication is absorbed and distributed In elderly decreased body fat affects medications how? - CORRECT ANSWERS-need fat to transport medications and some drug metabolism is dependent on body weight When prescribing medication, we must understand that liver function declines with age due to.... - CORRECT ANSWERS-decreased blood flow to the liver, decreased hepatic enzymes What is the most important cause of adverse drug reactions? - CORRECT ANSWERS- ***overprescribing/polypharmacy

• end of life pain management
• MI
• labor & delivery
• cancer What are therapeutic uses for Fentanyl? - CORRECT ANSWERS-BREAKTHROUGH PAIN surgical pain severe pain opioid tolerant patients What are therapeutic uses for codeine? - CORRECT ANSWERS-MILD TO MODERATE PAIN cough What is MME and when to use it? - CORRECT ANSWERS-morphine milligram equivalent used for overdose(OD) assess where patient is at in their pain management and monitor them safely What is the PDPM and when to use it? - CORRECT ANSWERS--database to access to patient's prescription history of controlled substances used to ensure safe prescribing to prevent overdosing and polypharmacy
• use prior to starting opioid therapy and during opioid therapy Renal and hepatic insufficiencies with opioids 1)Codeine - CORRECT ANSWERS-stays in body longer & metabolism is effected Renal and hepatic insufficiencies with opioids

2. Morphine - CORRECT ANSWERS-neurotoxicity Renal and hepatic insufficiencies with opioids 3)Oxycodone - CORRECT ANSWERS-overdose can use with extreme caution and reduction of dosage Renal and hepatic insufficiencies with opioids 4)Fentanyl - CORRECT ANSWERS-monitor closely for sedation Risk factors for Opioid Use Disorder (OUD) - CORRECT ANSWERS-family history mental health disorder (anxiety, depression) social factors prior drug use pain management poly-substance abuse prescribe post surgery for long period of time

When to prescribe Naloxone? - CORRECT ANSWERS->50 mme/day prior hx of OD concurrent benzo use Drugs not safe to take with Opioids - CORRECT ANSWERS-Benzos Alcohol CNS depressants Tricyclic Barbituates Antihistamines Antiseizure What are some provider responsibilities when prescribing Opioids? - CORRECT ANSWERS-patient education & safety documentation check PDMP set goals urinalysis discuss risks vs benefits contract offer alternative pain control options In what patient population are statins contraindicated? (prescribed for ages 10 or greater) - CORRECT ANSWERS-pregnant women hepatic impairment patients taking colchine In what patient population is Warfarin contraindicated? - CORRECT ANSWERS- pregnancy (give heparin instead) What patient population needs a lower dose of Warfarin? - CORRECT ANSWERS- children elderly What blood pressure medications are ok to use during pregnancy? - CORRECT ANSWERS-Labetalol Methyldopa Quinidine and _______ should NOT be use concurrently. - CORRECT ANSWERS- Digoxin (increase dig levels) - if used would have to decrease the dose Give some examples of Warfarin drug-drug interactions... - CORRECT ANSWERS- Aspirin Anticoagulants Vitamin K

2)ACE & ARBs 3)Thiazides (CCB is second choice) What are some contraindications of ACE inhibitors? - CORRECT ANSWERS- pregnancy (2nd & 3rd trimester) bilateral renal arterial stenosis What are some contraindications for Ranolazine? - CORRECT ANSWERS-pre-existing or hx of QT prolongation or are taking meds for QT prolongation What are some contraindications for Beta Blockers? - CORRECT ANSWERS-AV heart block Clinical tools used to treat hyperlipidemia? - CORRECT ANSWERS-ASCVD Colchine is given for acute....... - CORRECT ANSWERS-gouty flareups not prophylatically NSAIDS are first line of treatment for pain associated with.... - CORRECT ANSWERS- gouty flareups What would be the next medication prescribed for an acute gouty flareup if NSAIDs are ineffective? - CORRECT ANSWERS-Glucocorticoid (prednisone) 3 or more attacks of gout per year, the APN would prescribe - CORRECT ANSWERS- allopurinol or colchicine for prophylactic long-term treatment Colchicine should not be taken with what medications? - CORRECT ANSWERS-Statins (increase rhabdomyolysis) Colchicine - CORRECT ANSWERS-Nausea, vomiting, diarrhea, myelosuppression, and myopathy Allopurinol - CORRECT ANSWERS-Scare can develop, generally well tolerated with minimal GI and neurological effects Probenecid (will be on test) - CORRECT ANSWERS-Take with food to minimize GI effects and drink 2.5-3L water to prevent uric acid crystals formations in the kidneys Colchicine requires.... - CORRECT ANSWERS-a liver and renal dose adjusting Lesinurad should be combined with what other gout medication? - CORRECT ANSWERS-Allopurinol due to the fact that Lesinurad can cause renal failure Premedication of what two drugs should occur before taking Pegloticase? - CORRECT ANSWERS-Antihistamines & Glucocorticoids - in order to avoid an infusion reaction

Initiation of Allopurinol can elicit an acute gouty attack. What can be taken in conjunction to prevent that? - CORRECT ANSWERS-Colchicine, NSAIDs Complications of untreated gout - CORRECT ANSWERS-joint erosion - kidney stones - crystallized uric acide tofi - painful lumps filled with uric acid crystals under the skin Teraparatide ________ bone reabsorption and _________ bone deposition - CORRECT ANSWERS-Increases; Increases Patient education on Teraparatide..... - CORRECT ANSWERS--get enough Ca and Vit D in their diet

• report any bone pain, weakness, excess fatigue, confusion (can be s/s of increase Ca levels)
• 2 year limit with use of this drug d/t osteosarcoma risk Denosumab adverse effects - CORRECT ANSWERS-decreased immune system Osteonecrosis of jaw (ONJ) - jaw pain, soreness Patient education on Denosumab - CORRECT ANSWERS-report of any recent dental surgery infection hand hygiene increased bruising increased use of fx after discontinue of use dermatological issues (i.e. eczema, rash) Estrogen black box warning - CORRECT ANSWERS-increase risk of endometrial cancer, DVT, PE and Dementia Raloxifene black box warning - CORRECT ANSWERS-DVT, PE, and risk of stroke to postmenopausal women with heart disease Teriparatide black box warning - CORRECT ANSWERS-causes Osteosarcoma in animal testing Baseline data for all DMARDS - CORRECT ANSWERS-CBC, WBC, pregnancy, renal & hepatic function, malignancy, rule out TB and hepatitis, vaccine status(all vaccines should be done prior to tx), doing skin checks Baseline Diagnostics for all DMARDS - CORRECT ANSWERS-CXR (r/o TB) Opthalmic Exam (check for crystals in eye) EKG (check for bundle branches) Pulmonary consult (check lungs for interstitial disease)

Which dietary supplements can interfere with the absorption of Ibandronate? - CORRECT ANSWERS-Calcium or iron supplements vitamins with minerals antacids containing calcium, magnesium or aluminum. What is the benefit of using the combination Buprenorphine and Naloxone? - CORRECT ANSWERS--Pre-treating with Naloxone can prevent toxicity from buprenorphine; however, naloxone cannot reverse toxicity that has already developed.

• Buprenorphine is a partial opioid agonist that inhibits opiate receptors & decreases cravings, while Naloxone, works to counteract effects of opioids. Examples of pure opioid agonists - CORRECT ANSWERS--Fentanyl
• Morphine
• Oxycodone
• Hydromorphone (Dilaudid)
• Methadone Rules around prescribing schedule II drugs - CORRECT ANSWERS--rules regulated by DEA
• providers required to have a DEA license
• info required on RX (date of issue, name, address, DOB, clinician name, address & DEA #, drug name, strength, form & quantity prescribed)
• limits on # of refills & quantity prescribed
• each state decides practitioners' practice level (independent or restrictive) What is used to calculate the patient's overdose risk? - CORRECT ANSWERS- MME/day (Total amt of each opioid use x its conversion factor - then add them all up & it will give you the total mme/day) The higher the dose the increased chance of opioid use disorder (OUD) and death.

90 MME/day - CORRECT ANSWERS-How would you know when to refer someone to a pain specialist for pain management? 50 MME/day - CORRECT ANSWERS-When should naloxone be prescribed for a patient? How does renal and hepatic function impact medication levels in the body? - CORRECT ANSWERS--Impaired renal & hepatic function lead to decreased medication metabolism & excretion from the body

• increased drug levels in the body can cause toxicity What are possible outcomes if Tramadol is prescribed to a patient taking a monoamine oxidase inhibitor (MAOI)? - CORRECT ANSWERS-serotonin syndrome & hypertensive crisis

(Tramadol inhibits the uptake of norepinephrine when taken w/an MAOI) Three types of acute pain - CORRECT ANSWERS-1. Somatic

2. Visceral
3. Referred Who determines and regulates prescriptive authority? - CORRECT ANSWERS--State mandate it under the jurisdiction of the health professional board. (state board of nursing, board of medicine or board of pharmacy).

• Federal government controls drug regulations but has no control over prescriptive authority.
• Prescriptive authority is the legal right to prescribe drugs. How does limited prescriptive authority impact patients within the healthcare system? - CORRECT ANSWERS-Barriers include quality, affordable, and accessible patient care. Can increase patient waits Pregabalin (Lyrica) - CORRECT ANSWERS--used to treat postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with diabetic neuropathy
• Schedule V Controlled Substance
• D/C med slowly over 1 week
• abrupt D/C can cause seizures & withdrawal s/s risk factors of opioid use disorder - CORRECT ANSWERS-Mental health disorder, former nonfatal overdose Poverty. Unemployment. Family history of substance abuse. Personal history of substance abuse. Young age. History of criminal activity or legal problems including DUIs. Regular contact with high-risk people or high-risk environments. What happens when Quinidine and Digoxin are combined? - CORRECT ANSWERS-An increase in serum digoxin concentration can lead to digoxin toxicity When carbamazepine is prescribed with warfarin.... - CORRECT ANSWERS-it may reduce the efficacy of warfarin making it less effective ACE (renal protective) - CORRECT ANSWERS-best med to treat HTN for someone w/diabetes best med to treat HTN for pregnant patient or someone wishing to become pregnant - CORRECT ANSWERS-1) beta blocker (Labetalol & Methyldopa)

Pirfenidone - CORRECT ANSWERS-anti-fibrotic, antioxidant and anti-inflammatory; Pulmonary Fibrosis used in HF patients with fibrotic changes The effects of cardiac glycosides in heart failure patients - CORRECT ANSWERS- ****Slowed heart rate Increased force of myocardial contraction Increased cardiac output and renal perfusion Increased urine output and decreased blood volume Decreased conduction velocity through the AV node (reverses s/s of HF) For gout, what should be administered with Febuxostat? - CORRECT ANSWERS- NSAID or Colchicine drugs interactions with allopurinol - CORRECT ANSWERS-blood thinners and didanosine NSAIDs drug interactions - CORRECT ANSWERS-ACE-inhibitors (they block that anti-HTN effects by blocking production of vasodilatory and natriuretic prostaglandins) Corticosteroids (increase frequency/severity of GI ulceration) Warfarin (increased risk of bleeding) therapeutic response of Methotrexate - CORRECT ANSWERS--acts faster than all DMARDs in 3 to 6 wks (first choice)

• immunosuppression secondary to reducing the activity of B & T lymphocytes Pharmacological treatment of Osteoarthritis - CORRECT ANSWERS-1) Aspirin

2. NSAIDs
3. Vitamin D & Calcium Supplements 4)Celecoxib
4. no glucocorticoids Nonpharmacological treatment of Osteoarthritis - CORRECT ANSWERS-Physical therapy Exercise Weight Management Vitamin D and Calcium Ice packs and heating pads Assistive devices Joint taping Atherosclerotic Cardiovascular Disease (ASCVD) risk score - CORRECT ANSWERS- estimates risk of developing ASCVD (MI or stroke) within 10 years Predicts 10 year risk for ASCVD event among patients who are between ages 40-79. Calculation based on:

• Sex, Age, Race
• Total cholesterol and HDL
• SBP
• Tx for HTN/DM
• Smoking status When is ASCVD risk score used? - CORRECT ANSWERS-identifying patients who would benefit from the use of statins