NU641/ NU 641 MIDTERM EXAM: (NEW 2024/ 2025 UPDATE) ADVANCED CLINICAL PHARMACOLOGY| QS&A, Exams of Nursing

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NU641/ NU 641 MIDTERM EXAM: (NEW 2024/

2025 UPDATE) ADVANCED CLINICAL

PHARMACOLOGY| QS & AS| GRADE A| 100%

CORRECT (VERIFIED ANSWERS)

first line drug for strep throat - ANS ✓penicillin v potassium PO x10 days if allergic to PCN, give amoxicillin before prescribing antiHTN meds to newly diagnosed pt - ANS ✓EKG & blood work thiazide diuretics - ANS ✓-cause ED

• first line of tx for uncomplicated stage I HTN PCN allergy - ANS ✓use macrolides instead amoxicillin - ANS ✓avoid in mono patients complication of quinolones - ANS ✓-Achilles tendon rupture

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• do not use in children under 18 because of growing cartilage Benadryl - ANS ✓avoid in elderly use Claritin instead spironolactone - ANS ✓-potassium sparing diuretic
• caution w/ ACE: watch for hyperkalemia warfarin/coumadin - ANS ✓-do not take garlic, St. john's wart
• increases bleeding time sat john's wart - ANS ✓-used for depression, menopausal symptoms
• decreases effectiveness of digoxin & birth control (causes breakthrough bleeding)
• do not use with celexa antiplatelet meds - ANS ✓-garlic can exaggerate effects & inhibit action of platelets in the body
• ex: indomethacin, dipyridamole, Plavix, aspirin blood thinners - ANS ✓-aspirin & warfarin
• avoid garlic: can increase risk of bleeding

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acute serotonin syndrome - ANS ✓-occurs form high levels of serotonin accumulating in the body due to introduction of a new drug or increase in the dose

• s/s: acute onset with rapid progression; high fever, muscular rigidity, mental status changes, hyperreflexia/clonus, uncontrolled shivering, dilated pupils (mydriasis)
• high risk when combining two drugs that block serotonin
• ex: SSRI with MAOI, tricyclic antidepressants, triptans, tryptophan
• if switching to another drug affecting serotonin, wait a minimum of 2 weeks prophylactic treatment of migraines - ANS ✓-propranolol (BB)
• neurontin
• Prozac
• topamax
• elavil potassium-sparing diuretic - ANS ✓-Aldactone (spironolactone)
• causes galactorrhea (milky nipple discharge unrelated to the normal milk production of breast-feeding)
• avoid with severe renal disease treatment of c. difficile & colitis - ANS ✓metronidazole (flagl)

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which may cause orthostatic hypotension - ANS ✓-terazosin(hytrin): alpha blocker; selective alpha 1 antagonist used for BPH

• clonidine tricylcic antidepressants (TCA) adverse effects - ANS ✓anticholinergic
• dry mouth
• urinary retention
• dilated pupils
• flushing
• tachycardia
• confusion hydrochlorothiazide (HCTZ) - ANS ✓-for HTN
• good for patients with osteopenia & osteoporosis
• do NOT use in gout patients. decreases excretion of calcium
• side effects: hyperuricemia, hyperglycemia, hypokalemia side effect of Glucophage therapy - ANS ✓GI problems drugs that interact with theophylline - ANS ✓-erythromycin
• phenytoin sodium (dilantin)

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kidney failure - ANS ✓--HTN is 2nd leading cause

• assess BUN, creatinine, estimated GFR & UA nifedipine (Procardia XL) - ANS ✓-CCB
• side effects: peripheral edema, headache, dizziness, flushing, weakness peptic ulcer disease (PUD) - ANS ✓-commonly caused by H. Pylori or use of NSAIDs
• recommended short term treatment: Cytotec metronidazole (flagyl) - ANS ✓-produces disulfiram (antabuse) effect when combined with alcohol or medications dx: UTI & acute pharyngitis - ANS ✓-Levaquin (quinolone) can treat both (don't use in children younger than 18)
• if allergic to sulfa & PCN- do NOT give augmentin or bactrim drugs that interfere with metabolism of oral contraceptives - ANS ✓- tetracycline
• rifampin
• dilantin
• NOT CIPRO. CIPRO IS OKAY WITH ORAL BC

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UTI & allergy to sulfa - ANS ✓DON'T GIVE BACTRIM treatment of UTI in pregnant women - ANS ✓Nitrofurantoin crystal (Macrobid) propranolol - ANS ✓-first line treatment for essential tremor (controls symptoms, essential tremor cannot be cured)

• order EKG before prescribing
• avoid in pts with 2nd or 3rd degree heart block, bradycardia, or COPD azithromycin - ANS ✓-treatment of choice in healthy adults with CAP
• drug of choice for strep throat in pt with PCN or amoxicillin allergy CAP treatment - ANS ✓-first line in healthy adults: azithromycin
• doxy ONLY if allergic to macrolide
• levaquin & augmentin are NOT recommended as first line in healthy patients bronchitis - ANS ✓NO antibiotics (viral) cetirizine - ANS ✓second generation antihistamine that can be given to pediatric pts

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onset CHF s/s - ANS ✓dyspnea, JVD, peripheral edema hyperlipidemia treatment - ANS ✓-may need more than one drug

• if on fibric acid derivative, DO NOT add reductase inhibitor (risk of rhabdo) lower LDL & triglycerides - ANS ✓-statin (HMG-CoA reductase inhibitor)
• Ezetimibe (cholesterol lowering medication). prevents absorption of cholesterol in the intestine
• lifestyle changes (diet, weight loss, exercise) asthma classifications - ANS ✓-intermittent: normal FEV between exacerbations, FEV>80%
• mild persistent: FEV>80%
• moderate persistent: FEV 60-80%
• severe persistent: FEV<60% vitamin B12 - ANS ✓pernicious anemia vitamin B6 (pyridoxine) - ANS ✓-prevent peripheral neuropathy in patients taking isoniazid for TB
• helps the body to use & store energy from protein & carbs in food

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• helps the body form hemoglobin antiretrovial therapy (ART) goal of treatment - ANS ✓-prevention of vertical HIV transmission
• improvement of quality of life
• prolonged survival adult treatment of sinusitis - ANS ✓amoxicilin-clavulanate 500 mg BID x7 days first line treatment for afebrile 2yo w/ otitis media - ANS ✓amoxicillin nicotine nasal spray dose - ANS ✓ 1 - 2 sprays in each nostril per hour, up to 40 sprays per day GOLD guidelines for stable COPD - ANS ✓bronchodilators corticosteroids oxygen antibiotics alpha-trypsin augmentation therapy (related to emphysema) immunizations smoking cessation beta2-agonists

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• short acting: ipratropium, oxitropium
• long-acting: tiotropium, glycopyrronium bromide
• adverse effects: inhaled are poorly absorbed which limits systemic effects; dry mouth methylxanthines - ANS ✓-theophylline- most common; clearance declines with age
• bronchodilator effect
• theophylline with salmeterol show greater improvement in FEV
• adverse effects: dose-related toxicity combination bronchodilator therapy - ANS ✓-combining drugs with different mechanisms/durations increases degree of bronchodilation with a lower risk of side effects
• combination of short acting BA & short acting methylxanthines in improving FEV/symptoms
• formoterol & tiotropium in separate inhalers
• lower dose, twice daily regimen with LABA/LAMA is also effective anti-inflammatory agents COPD - ANS ✓for exacerbations

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inhaled corticosteroids - ANS ✓-in combination with long-acting bronchodilator therapy.

• adverse effects: oral candidiasis, hoarse voice, skin bruising, pneumonia triple inhaled therapy COPD - ANS ✓-LABA/LAMA plus ICS may improve lung function oral glucocorticoids COPD - ANS ✓-side effects: steroid myopathy (muscle weakness, decreased functionality, respiratory failure)
• acute management of exacerbations. NOT for daily use phosphodiesterase-4 (PDE4) inhibitors - ANS ✓-Roflumilast reduces exacerbations treated with systemic corticosteroids in patients with chronic bronchitis & COPD
• adverse effects: nausea, reduced appetite, weight loss, abdominal pain, diarrhea, sleep disturbance, headache antibiotics for COPD - ANS ✓macrolide antibiotics to reduce exacerbations amoxicillin/clavulanic acid tetracycline second line: respiratory fluoroquinolones

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COPD exacerbation treatment- moderate - ANS ✓SA bronchodilators plus antibiotics and/or oral corticosteroids COPD exacerbation treatment- severe - ANS ✓-requires hospitalization mild asthma treatment - ANS ✓-step 1 therapy: SABA PRN for symptoms mild persistent asthma treatment - ANS ✓low-dose ICS daily BA PRN (if using 2 days per week, then step up therapy) moderate asthma treatment - ANS ✓-medium-dose ICS OR low-dose ICS with LABA (adults) OR medium-dose ICS plus leukotriene receptor modifier

• SABA may be used.
• Exacerbations may require oral corticosteroids. severe persistent asthma treatment - ANS ✓-Step 4 therapy: Medium-dose ICS plus LABA OR medium-dose ICS and a leukotriene modifier or theophylline
• Step 5 therapy: High-dose ICS plus LABA
• Step 6 therapy: high-dose ICS plus LABA and oral corticosteroids; consult asthma specialist

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bronchodilators - ANS ✓-BA (short or long acting vs ultra-long acting)

• methylxanthine; selective phosphodiesterase (PDE)
• muscarinic agents
• corticosteroids: inhaled, oral, PDE4 inhibitor adverse effects methylxanthines - ANS ✓-nausea/vomiting
• increased gastric acid secretion (and subsequent gastroesophageal reflux)
• polyuria
• insomnia
• palpitations
• headaches
• tremors Varenicline (Chantix) - ANS ✓-for smoking cessation; start 1 week before quit date Varenicline (Chantix) side effects - ANS ✓-Common: nausea, constipation, diarrhea, gas, abdominal pain, vomiting, heartburn, bad taste in the mouth, dry mouth, increased or decreased appetite, toothache, trouble falling asleep or staying asleep, unusual dreams or nightmares, headache, lack of energy, back, joint, or muscle pain, abnormal menstrual cycles

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• do not take if on medication for ED or PAH
• side effect: headache Viagra - ANS ✓treats ED & pulmonary arterial hypertension (HTN in the lungs) BB - ANS ✓-antiHTN
• for prevention of sudden cardiac death reduces ventricular arrhythmias
• contraindications: asthma, 2nd & 3rd degree AV block, bradycardia, COPD, DM (will mask hypoglycemic effect)
• side effects: fatigue, depression
• wean off slowly to avoid risk of severe rebound HTN
• abrupt withdrawal: severe angina, MI, ventricular arrhythmia's, death
• taper dose by 1/2 every 4 days CCB - ANS ✓-worsens GERD
• preferred in HTN patients with osteopenia or osteoporosis
• blocks calcium from leaving kidneys
• do not use in pts with 2nd or 3rd degree heart block, bradycardia, or CHF
• side effects: peripheral edema, headache
• good for isolated BP in elderly

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Bactrim - ANS ✓-NOT in patients on Coumadin; can increase risk of bleeding. watch for bleeding from gums, nosebleeds, unusual bruising, dark stools anticholinergics - ANS ✓-Atrovent, Spiriva

• NOT for use in narrow angle glaucoma, BPH, or bladder neck obstruction
• side effects: sedation, anorexia, dry mouth, confusion, constipation, urinary retention, BPH ACE - ANS ✓-contraindicated in renal stenosis
• side effects: cough, angioedema, hyperkalemia
• management of htn & diabetes
• D/C in pregnancy. caution with childbearing women
• preferred for diabetics & mild CKD ARB - ANS ✓-contraindicated in renal stenosis/severe kidney disease
• D/C in pregnancy. caution with childbearing women
• preferred drug class in pts with gout (Losartan)
• preferred for diabetics & mild CKD metformin - ANS ✓contraindicated with renal disease