NR566 FINAL EXAM VERSION 1 AND 2 ADVANCED PHARMACOLOGY FOR FAMILY CARE GRADED A+ LATEST 20, Exams of Nursing

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NR566 FINAL EXAM VERSION 1 AND 2 ADVANCED

PHARMACOLOGY FOR FAMILY CARE GRADED A+ LATEST

What are some potential drug interactions with Lithium? - ANSWER✔✔Diuretics, NSAIDS, Anticholinergics (Concerned w/dehydration & sodium balance) What is the black box warning for tricyclic antidepressants and all other depressants as well? - ANSWER✔✔risk for suicide What is the preferred administration route of alprostadil (used to treat ED)? - ANSWER✔✔injection into the penis or by insertion into the urethra What is the normal lithium range? - ANSWER✔✔ 0 .4- 1 mEq/L (>1.5 is getting towards toxicity range) What is the role of androgens in treating anemia? - ANSWER✔✔synthesis of erythropoietin When is it safe to use progestin for hormone replacement therapy? - ANSWER✔✔management of dysfunctional uterine bleeding, amenorrhea or endometriosis

Best choice of medication for Gonorrhea (gonococcal infection)? - ANSWER✔✔Ceftriaxone Which of these drugs are known to elevate phenytoin levels? - ANSWER✔✔diazepam isoniazid cimetidine carbamazepine phenobarbital alcohol What are some potential adverse effects of finasteride (Proscar - BPH)? - ANSWER✔✔decreases ejaculation volume and libido gynecomastia What are some potential adverse effects on Nonselective al Blockers (used to treat BPH & HTN)?

• ANSWER✔✔Hypotension Fainting Dizziness Somnolence Nasal Congestion

What are some potential adverse effects of Phosphodiesterase-5 Inhibitor (used to treat ED)? - ANSWER✔✔Hypotension and Priapism A prolonged and unwanted erection of the penis that occurs without sexual stimulation. This causes penile pain, rigid penile shaft, and erection that last for more than 4 hours without sexual stimulation. - ANSWER✔✔Priapism What are typically the best antibiotics for Chlamydia in adults? - ANSWER✔✔Azithromycin or doxycycline What are typically the best antibiotics for Gonorrhea in adults? - ANSWER✔✔ceftriaxone IM plus azithromycin oral What should we prescribe for BV and/or Trichomoniasis? - ANSWER✔✔Metronidazole PO or Clindamycin Cream What is our first-choice drug for Syphilis? - ANSWER✔✔Penicillin G What are some good treatment options for Herpes Simplex Virus? - ANSWER✔✔Acyclovir (firs one typically) Famciclovir

Valacyclovir What patient education should we provide regarding SSRIs? - ANSWER✔✔don't abrupt discontinuation b/c it can result in withdrawal syndrome Why choose local estrogen over systemic? - ANSWER✔✔treatment of vulval and vaginal atrophy associated with menopause MAO inhibitors are appropriate for a patient... - ANSWER✔✔able to strictly adhere to avoiding tyramine containing foods (beer, avocado, aged cheese, persevered/fermented foods, cured meat) When would we use systemic estrogen? - ANSWER✔✔hot flashes night sweats What is the name of some 5 alpha reductase inhibitors? - ANSWER✔✔Dutasteride (Avodart) Finasteride (Proscar) What are the names of some alpha 1 blockers? - ANSWER✔✔Silodosin and Tamsulosin

What are the names of some phosphodiesterase 5 inhibitors? What type of education is needed with these meds? - ANSWER✔✔Sildenafil (Viagra) Tadalafil (Cialis) if they have an erection >4hrs must go to emergency room - be mindful of hypotension What is the most common adverse effect of medications for BPH? - ANSWER✔✔sexual dysfunction and hypotension With prescription BPH meds, prostate shrinking occurs slowly over how many months? - ANSWER✔✔6 to 12 months Which medications are used to treat panic disorder? - ANSWER✔✔Some SSRIs, SNRIs, tricyclic antidepressants (TCAs), and MAOIS What medications can be used on a routine basis for social anxiety disorder? - ANSWER✔✔SSRI, paroxetine (Paxil) and sertraline (Zoloft) What medication can be used on an as needed basis for social anxiety disorder? - ANSWER✔✔Benzos, propranolol

.... - ANSWER✔✔EP

1st generation antipsychotics DO NOT cause... - ANSWER✔✔weight gain diabetes dyslipidemia Which medication decrease sleep latency and prolonged sleep duration? - ANSWER✔✔Trazadone Which medication helps patients fall asleep but is not for maintaining sleep? - ANSWER✔✔Zaleplon (Sonata) Which medication is best for people who have difficulty falling asleep? - ANSWER✔✔Zolpidem (Ambien) What are the names of some benzodiazepine-like drugs? - ANSWER✔✔Eszopiclone (Lunesta) and Zaleplon (Sonata) What is the name of a Melatonin receptor agonist? - ANSWER✔✔Ramelteon (Rozerem)

How do we initiate oral contraceptive (OC) treatment? - ANSWER✔✔start on first day of menstrual cycle or the first Sunday after What teaching should be provided for OC? - ANSWER✔✔If >1 pill missed in the first week, take one pill ASAP, use back-up method for 7 days What is NOT a contraindication for OCs? - ANSWER✔✔ovarian cancer What are contraindications for OCs? - ANSWER✔✔Breast cancer Pregnancy Hx of Thromboembolism women >35 yrs old who continue to smoke What is the first-choice medication for Parkinsons? - ANSWER✔✔Carbidopa/Levedopa What medication is used to treat "off" times including "wearing off" experiences in Parkinsons?

• ANSWER✔✔Dopamine agonists COMT inhibitors MAO-B inhibitors

What is the difference between "off" times versus "wearing off" times? - ANSWER✔✔off times are random and not correlated to blood levels wearing off times - med is wearing off Pramipexole adverse reactions.... - ANSWER✔✔nausea dizziness daytime somnolence insomnia constipation weakness hallucinations sleep attacks impulse control problems What medication interaction may occur with Phenytoin and OC use? - ANSWER✔✔Decrease effectiveness of OC What are some non-psychiatric drugs that can be used to treat Manic Depressive Disorder (Bipolar)? - ANSWER✔✔anti-epileptic (Lithium/Lamictal - most common)

When should Lithium levels be drawn? - ANSWER✔✔every 2-3 days during initial therapy and every 3-6 months for maintenance What is the potential risk of taking Kava? - ANSWER✔✔hepatoxicity St John's Wort can reduce the effectiveness of what drug? - ANSWER✔✔oral contraceptives What potential adverse effects of gingerroot? - ANSWER✔✔hypoglycemia, hypotension What are some common adverse effects of Flax Seed? - ANSWER✔✔bloating, flatulence, abdominal cramping What adverse effects may Black Cohosh cause? - ANSWER✔✔rash, headache, dizziness With testosterone replacement therapy, when should T levels be drawn? - ANSWER✔✔14 days after initiation of therapy and then periodically after that What important patient teaching should be provided regarding topical testosterone application?

• ANSWER✔✔women and children should avoid skin-to-skin contact with application sites (virilization and teratogenic)

When is it appropriate to initiate short-term androgen therapy? - ANSWER✔✔psychologic distress of delayed sexual maturation (around 14-15 yrs old) Expected therapeutic effects of Androgen therapy include... - ANSWER✔✔increased libido increased ejaculation volume support expression of secondary sex characteristics promote synthesis of erythropoetin What are some potential adverse effects of Androgens? - ANSWER✔✔Virilization Accelerated Epiphyseal Elevated LDL Prostate CA Hepatitis What monitoring is needed for Androgen Therapy? - ANSWER✔✔CBC Lipid Panel PSA LFTs

What is the first-line treatment for migraine prevention? - ANSWER✔✔Beta Blockers What is the first-line abortive treatment for migraines? - ANSWER✔✔Triptans How many days a week should abortive migraine medications be limited to? - ANSWER✔✔1 or 2 days a week (any more use can cause rebound migraines) When is sumatriptan contraindicated? - ANSWER✔✔hx of ischemic heart disease, MI, uncontrolled HTN What are some alternative options for Migraine prevention? - ANSWER✔✔Antiepileptics TCA Estrogen immunoglobulin G2 monoclonal antibodies What are the names of some SSRIs? - ANSWER✔✔Fluoxetine Citalopram Escitalopram

Paroxetine Sertraline What are some potential adverse effects of Venlafaxine (SNRI)? - ANSWER✔✔headache, anorexia, nervousness, sweating, somnolence and insomnia (norepinephrine - can increase HR-stimulant) What are some potential adverse effects of MAOIs? - ANSWER✔✔HTN crisis cause by dietary tyramine Orthostatic Hypotension CNS stimulation How should we advise a patient to take OC to achieve an extended menstrual cycle? - ANSWER✔✔take the active pills for 84 days straight What effect does CYP450 inhibitors or inducers have on OCs? - ANSWER✔✔may reduce OC blood levels, therefore causing breakthrough bleeding or spotting What are the benefits of progestin-only contraception? - ANSWER✔✔do not cause thromboembolic disorder, headaches and nausea are less

What are the draw backs of progestin-only contraception? - ANSWER✔✔less effectives, cause more irregular bleeding, must take at exact same time daily (if take even 3hrs late there is a risk for pregnancy) What are the most effective forms of contraception? - ANSWER✔✔Nexplanon or IUD When should we use precaution when prescribing Memantine? - ANSWER✔✔Hx of CVD hepatic or renal impairment Opthalmic disease We must use cause when prescribing Rivastigmine to patients with... - ANSWER✔✔PUD Bradycardia Sick sinus syndrome urinary obstruction lung disease What is the typical daily dose of Aricept for mild to moderate Alzheimer's disease? - ANSWER✔✔5mg daily

What are dosing considerations for Memantine? - ANSWER✔✔reduce dosage in patients with moderate renal impairment What are some potential adverse effects of Cholinesterase inhibitors? - ANSWER✔✔nausea vomiting dyspepsia diarrhea dizziness headache What is the typical oral starting adult dose for Azithromycin? - ANSWER✔✔ 250 - 500mg What is the typical oral starting adult dose for Eryhthromycin? - ANSWER✔✔ 1000 - 2000mg What is the usual daily adult dose of Tinidazole? - ANSWER✔✔1000mg What strengths do oral Acyclovir come in? - ANSWER✔✔Capsule - 200mg Tablet - 400mg and 800mg

A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she does not want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about:

1. Depo Provera.
2. Estraderm.
3. low-dose estrogens.
4. Premarin vaginal. - ANSWER✔✔ANS: D Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects. Depo Provera is a progesterone and is not indicated. Transdermal estrogen is used to treat hot flushes. Low-dose estrogens still have systemic effects. A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that:
5. an estrogen-progesterone product will reduce side effects.
6. an intravaginal preparation may be best for her.
7. side effects of ET are uncommon among women her age.
8. transdermal preparations have fewer side effects. - ANSWER✔✔ANS: D Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are

most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she cannot take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to:

1. decrease her risk of endometrial cancer.
2. increase bone resorption to prevent fractures.
3. lower her risk of myocardial infarction (MI).
4. prevent deep vein thrombosis (DVT). - ANSWER✔✔ANS: A In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT. A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching?
5. "Because I am not at risk for uterine cancer, I can take hormones indefinitely."
6. "I can take estrogen to reduce my risk of cardiovascular disease."
7. "I should take the lowest effective dose for the shortest time needed."

4. "I will need a progestin/estrogen combination since I have had a hysterectomy." - ANSWER✔✔ANS: C For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens. A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct?
5. "Estrogen can help reverse bone loss."
6. "Hormone therapy increases bone resorption."
7. "Hormone therapy does not decrease fracture risk."
8. "When hormone therapy is discontinued, bone mass is quickly lost." - ANSWER✔✔ANS: D Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount. The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my:
9. waistline and shoulders."
10. abdomen and arms."

3. breasts and abdomen."
4. thighs and calves." - ANSWER✔✔ANS: D The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen. A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching?
5. "ET can provide protection against coronary heart disease and reverse osteoporosis."
6. "EPT is generally safer than ET, especially in women who have undergone hysterectomies."
7. "In women with established coronary heart disease, EPT can protect against myocardial infarction."
8. "Principal benefits of ET are suppression of menopausal symptoms and prevention of bone loss." - ANSWER✔✔ANS: D ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease.

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication?

1. Raloxifene reduces the risk of thromboembolism.
2. The drug is associated with an increased risk of breast cancer.
3. Use of this drug increases the risk of endometrial carcinoma.
4. Vasomotor symptoms are a common side effect of this drug. - ANSWER✔✔ANS: D Raloxifene can induce hot flashes in patients taking this drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer. A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?
5. The patient should ask her provider about an OC with less progestin.
6. The patient should discuss an alternative method of birth control prior to surgery.
7. The patient should request an OC containing less estrogen after surgery.
8. The patient should take the OC at bedtime after her surgery to reduce side effects. - ANSWER✔✔ANS: B Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:

1. clean the ring with warm water, reinsert it, and use condoms for 7 days.
2. discard the ring and insert a new ring after 1 week has passed.
3. discard the ring and insert a new one to begin a new cycle.
4. wash the ring in hot, soapy water, and reinsert it. - ANSWER✔✔ANS: A If a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water. An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraceptive method with the provider?
5. An intrauterine device with a spermicide
6. DMPA (Depo-Provera) and condoms
7. Tubal ligation and condoms
8. Progestin-only oral contraceptives - ANSWER✔✔ANS: B

This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her; patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and should not be used by young women because it is irreversible. Progestin-only oral contraceptives must be taken every day. A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

1. A 45-year-old married woman with four children.
2. A 30-year-old monogamous married woman.
3. An 18-year-old woman with multiple sexual partners.
4. A 35-year-old woman with a history of rosacea. - ANSWER✔✔ANS: C Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD. A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?
5. "I will need to use backup contraception if I miss a pill."
6. "Irregular bleeding is an indication that I should stop using this drug."

3. "The mini-pill is safer than combination OCs and is just as effective."
4. "The progestin-only mini-pill will prevent me from ovulating." - ANSWER✔✔ANS: A When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience. The mini-pill is slightly safer than combination OCs but not as effective. The mini-pill is a weak inhibitor of ovulation. A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:
5. before the first missed menstrual period."
6. the day after unprotected intercourse."
7. within 7 weeks of conception."
8. immediately after ovulation." - ANSWER✔✔ANS: C Mifepristone is most effective if it is used within 7 weeks of conception. The timing specified in the other responses is incorrect. A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:
9. question the patient about any possible missed doses of the pill.
10. reassure the patient that this is normal with this form of contraception.

3. recommend that she take a pregnancy test to rule out pregnancy.
4. suggest that she use a backup form of contraception until these symptoms resolve. - ANSWER✔✔ANS: B Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception. A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?
5. Begin taking the new product immediately.
6. Change products at the beginning of her next cycle.
7. Stop taking the old OC 1 week before starting the new OC.
8. Use an alternate method of contraception for 1 month before starting the new OC. - ANSWER✔✔ANS: B When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately; to stop the old product 1 week before starting the new product; or to use an alternate method of birth control between regimens. A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:

1. human papillomavirus (HPV) infections.
2. spontaneous abortions.
3. endometrial cancer.
4. increased transmission of the human immunodeficiency virus (HIV). - ANSWER✔✔ANS: D Spermicides that contain nonoxynol-9 have been linked to the increased transmission of HIV. Spermicides containing nonoxynol-9 have not been linked to HPV infections, spontaneous abortions, or endometrial cancer. A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?
5. The patient should ask her provider about an OC with less progestin.
6. The patient should discuss an alternate method of birth control.
7. The patient should request an OC containing less estrogen.
8. The patient should take the OC at bedtime to reduce side effects. - ANSWER✔✔ANS: C Breast tenderness, edema, and nausea are associated with estrogen; women experiencing these side effects may benefit from an OC with a lower estrogen dose. Lowering the progestin will not decrease these symptoms. It is not necessary to change birth control methods if side effects can be managed by altering the estrogen dose. Taking the OC at bedtime will not affect the symptoms.

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to: a. continue the pack, skip the inert pills, and use an additional form of contraception for 7 days. b. not to worry, because up to 7 days can be missed without an increased risk of pregnancy. c. take a pill immediately, continue the pack, and use an additional form of contraception for 1 month. d. take a pill now, continue the pack, skip the placebo pills, and start a new pack on week - ANSWER✔✔ANS: D If one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases. A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?

1. She should discard the inert pills and start a new pack during the honeymoon.
2. She should discontinue the oral contraceptives and use an alternative form of birth control.
3. She should discuss a prescription for an extended-cycle product with her provider.
4. She should discuss DMPA (Depo-Provera) injections in addition to the OC with her provider. - ANSWER✔✔ANS: A