PC 707 Final Safety Exam | 100% Correct Answers | Verified | Latest 2024 Version, Exams of Nursing

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PC 707 Final Safety Exam | 100% Correct

Answers | Verified | Latest 2024 Version

IgE mediated allergic reaction that happens after the 2nd exposure to the antigen? - ✔✔Type I Immediate hypersensitivity Delayed Allergic reaction involving T cell in the skin? - ✔✔Type IV Reaction Primary treatment for a Type 1 Allergic response? - ✔✔Epinephrine Adjunctive treatment for a Type 1 Allergic response - ✔✔ ‣ H1 Blockers ‣ Corticosteroids help prevent bi phasic reactions ‣ Bronchodilators provide some relief- One of the most Severe forms of a Type IV allergic reactions. - ✔✔‣ Stevens Johnson Syndrome ‣ Toxic epidermal necrolysis When considering a drug "re challenge" after reaction what are crucial factors the APRN must consider?

• ✔✔‣ What drug the patient reacted to ‣ The severity of the reaction (never again in Type I or severe type IV) most important What Black Box Warning does Carbamazepine & Lamictal carry? - ✔✔Potential life-threatening dermatologic reaction, including Steven's Johnson and Toxic Epidermal Necrolysis What Black Box Warning does Promethazine (Phenergan) antiemetic carry? - ✔✔Potential for life threatening respiratory depression in children. What Black Box Warning do Fluoroquinolones carry? - ✔✔Potential for tendon rupture

What Black Box Warning does SSRIs carry? - ✔✔Potential increased risk of suicide in teens. What Black Box Warning does opioids carry? - ✔✔Combining opioids & benzodiazepines can cause extreme sleepiness, slowed breathing & death Insulin/Sulfonaureas adverse effect - ✔✔Hypoglycemia! Tricyclic Antidepressants - ✔✔Very risky for overdose Nitrofurantoin (Macrobid) adverse effect - ✔✔Pulmonary Toxicity (rare ) Proton Pump Inhibitors Increases the risks for - ✔✔‣ Upon starting: Community acquired pneumonia ‣ Over time more likely to get infections like TB ‣ Over time possible increased potential for fractures Bisphosphonates potential risk - ✔✔osteonecrosis of the jaw As we age, our kidneys become smaller & there is a decrease in renal blood flow. Why is this a prescribing consideration? - ✔✔Decreased renal clearance of drugs As we age, our liver become smaller, has decreased blood flow & first pass metabolism decreases. Why is this a prescribing consideration? - ✔✔Decreased liver size also means decreased production of CYP 450 enzymes! So if you need to select a drug for the elderly, try to select drugs that use Phase 2 metabolism (not affected by age) Phase I is affected & involves the CYPs. AS we age, there is a decrease in total body water by 10-15%! Why is this a concern when prescribing for the elderly? - ✔✔Decrease in total body water results in decreased distribution of water soluble medications & causes increased serum levels of drugs. Why are the elderly at higher risk of Torsades de Points? - ✔✔Elderly tend to be on more drugs, so more of a chance to have multiple QT prolongation drugs.

Additional risk of TdP with low potassium, low magnesium & bradycardia- more common in the elderly. Afib more likely What are the concerns with anticholinergic drugs & the elderly? - ✔✔In the elderly Anticholinergic drugs can cause: ‣ Memory impairment, ‣ confusion, ‣ falls, ‣ hallucinations, ‣ tachycardia & ‣ acute angle glaucoma What class of drugs do you have to assess & monitor for Rhabdomyolysis? - ✔✔Statins Rhabdomyolysis S&S - ✔✔‣ muscle complaints do not involve joints, ‣ involve large muscle groups proximal to trunk, commonly legs, low back & ‣ are symmetrical. What to do if pt on statins c/o muscle pains s&s of rhabdomyolisis? - ✔✔‣ stop for 2-4 weeks, ‣ address the possibility of rhabdomyolysis by evaluating CK & creatinine & performing urinalysis for myoglobinuria ‣ If not Rhabdo- consider restarting lower does ‣ (look for d2d cyp issues). ‣ If Rhabdo- no more statins ever. NSAIDS & clotting - ✔✔NSAIDS interfere with clotting & promote bleeding NSAIDS & GI bleed - ✔✔strip stomach lining & increase chance of GI bleed NSAIDs & HTN - ✔✔cause fluid retention- & can worsen HTN, CHF, Edema, & cause repeat MIs

NSAIDs & Kidneys - ✔✔can damage kidneys & advance kidney disease NSAIDs & Reyes syndrome - ✔✔contribute to Reyes syndrome in children with viral illnesses What is an important thing to remember about asthma treatment? - ✔✔The difference & appropriate use of rescue drugs vs. maintenance drugs teach your patients about this difference! Why so many asthma related deaths? - ✔✔LABA use as a rescue drug. What are some issues with MAOIs? (examples: Nardil, Emsam, Parnate) - ✔✔‣ MAOIs are anticholinergic issues ‣ Severe diet restrictions ‣ many drug to drug interactions What hormone is prednisone similar to? - ✔✔cortisol, a hormone naturally made by your adrenal glands. What happens if you take prednisone for more than a few weeks? - ✔✔your adrenal glands decrease cortisol production. Rationale for tapering patients off steroids (if they have been on them for more than 2 weeks) - ✔✔A gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal function. Bioavailability - ✔✔The degree to which or rate at which a drug or other substance is absorbed or becomes available at the site of physiological activity after administration Protein Binding - ✔✔Many drugs bind to protein in the blood. Drugs bound to the protein are not active. The proteins do not release the drug until saturated Agonist - ✔✔chemical that binds to a receptor and activates the receptor to produce a biological response.

Partial agonists - ✔✔bind and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist, even at maximal receptor occupancy. Antagonist - ✔✔a chemical that binds to a receptor and blocks the action of the agonist. Enzyme inhibition - ✔✔Results in decreased metabolism and result in increased pharmacologic action of drug. The drug stays in the body longer. Enzyme Induction - ✔✔Increasing the metabolic pathway and results in less action of drug- the drugs exits the body faster Prodrugs - ✔✔pharmacologically inactive medications that are metabolized into an active form within the body. Codeine is an example Ultra Rapid Metabolizer - ✔✔Someone who metabolized at an ultra fast rate. For example, if a particular CYP450 variation makes someone a rapid metabolizer of a drug, he or she may process it so fast that the drug won't have a chance to reach optimal blood levels, leading to limited amounts of drug that can act on the patient's system. However if a drug is a pro drug (like codeine) and the patient is an ultra rapid metabolizer- there is a sudden very large amount of active drug and the patient can overdose. Hepatic First Pass In drug metabolism - ✔✔when the concentration of drug is greatly reduce before it reaches systemic circulation. This is related to drugs that are orally administered. Half Life - ✔✔The time required for a quantity to reduce to half its initial value. Should a drug's half-life be very short, it would mean that the dosage would be given more frequently, to keep the levels in the body up and have a consistent therapeutic effect. If the drug is dosed at an intermittent dosing interval equal to this single half life, a predictable pattern of fluctuation and accumulation at chronic multiple dosing occurs, where the plasma concentration can be expected to fall in half during each dosing interval (fluctuation), and the multiple dosing steady-state levels of drug at any time during the dosing interval will be twice the levels of drug at that same time following the first dose (accumulation). Therapeutic Index - ✔✔The margin of safety that exists between the dose needed for the desired effect and the dose that produces unwanted and possibly dangerous side-effects. In general, the narrower this margin, the more likely it is that the drug will produce unwanted effects.

Maximal efficacy - ✔✔The maximum effect that a drug can produce regardless of dose. Potency - ✔✔the amount of agonist needed to elicit a desired response. Think of overdose- carfentanil (elephant tranquillizer) it is 100 Xs as potent as the same amount of fentanyl, 5,000 times as potent as heroin, and 10,000 times as potent as morphine. QT Prolongation - ✔✔‣ life threatening syndrome marked by a prolonged QT interval with episodes of electrocardiographic torsades de pointes. ‣ condition may be acquired as a result of drug administration. ‣ Usually caused by a combination of drugs that prolong Qt- so check interactions. ‣ Additional risk include low K, low magnesium and bradycardia. Beers List - ✔✔A list of medications that frequently cause side effects when administered to elderly patients. Among the medications on the list are those that cause prominent neuropsychiatric, renal, and anticholinergic side effects. It is important to know that these are guidelines and not prescribing protocols. In other words, these are both good tools to use to help you identify red flags and to identify necessary monitoring but they are not the final word on medication appropriateness. As the prescriber, you will need to consider potential risk, benefits, and alternatives. Polypharmacy - ✔✔the concurrent use of several different drugs. Polypharmacy is considered use of five or more medications including herbals and otcs Medicinal Foods - ✔✔"food which is formulated to be consumed or administered enterally under medical supervision and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation." This category is considered to be very limited. These medical foods are "...specially formulated and processed (as opposed to a naturally occurring foodstuff used in a natural state) for the patient who is seriously ill or who requires the product as a major treatment modality." These foods are exempted from the nutrition labeling required on other non-medical foods. What is CYP450 & what is the role of grapefruit juice? - ✔✔It is an enzyme involved in metabolism. Grapefruit juice "knocks it out" for 3 days.

If a drug needs CYP450 to leave the body, & there is not CYP450, the drug BUILD up for 3 days. If the drug makes you grow a green tail, then you have build up of the drug & end up with 3 green tails. Good Antibiotics Stewardship Meaning - ✔✔Knowing what really needs antibiotics & when to offer reassurance. Watchful waiting & alternative treatments. Keeping broader antibiotics for times when we really do need them & preventing resistance Antibiotics Police Antibiogram - ✔✔● Report generated by each hospital that shows local activity re: antibiotic resistance. ● Includes a list of drug names, organism group, whether it's gram - /+, and the percentage sensitive to a particular antibiotics Importance of Antibiograms - ✔✔● Helps you be familiar w/ the organisms commonly causing infections in your area. ● Textbook info may become outdated over time as resistance develops ●Being up to date with what is happening in your community will inform you of local development of microbial resistance What does the CDC recommend for MRSA abscess treatment? - ✔✔ Key differences in the timing live vs killed vaccines - ✔✔If live injectable virus given, has to be given together - if not, and doing two live viruses, have to be 4 weeks apart Vaccine Contraindications - ✔✔‣ Encephalopathy, ‣ true allergy (egg > influenza), ‣ do not give a live virus to ● pregnant patient ● immunosuppressed ● children under 1 Can a non type one allergy to PCN be given a Cephalosporin? - ✔✔

Cross Reactivity in allergic reactions - ✔✔occurs when the proteins in one substance (typically pollen) are similar to the proteins found in another substance (typically a food). For example, if you are allergic to birch tree pollen, you may also find that eating apples causes a reaction for you. Allergy types - ✔✔ Levaquin - ✔✔ Tetracycline Contraindication - ✔✔Children 8 and under and pregnancy Why is tetracycline contraindicated in <8yo & pregnancy? - ✔✔Causes Teeth discoloration can cause deposition on bones and bone growth restriction. sulfa Drugs contraindications - ✔✔Pregnancy, Lactation, Infants < 2 months 3rd trimester, sulfa compounds compete for bilirubin binding sites on fetal and neonatal albumin=hyperbilirubinemia & kernicterus. Fluoroquinolones Contraindication - ✔✔in pregnancy & in children <18yo Fluoroquinolones Black Box Warning - ✔✔risk for tendon rupture (people >60, corticosteroid use, organ transplants). Photosensitivity. Lowers seizure threshold Metronidazole - ✔✔Avoid alcohol consumption during and up to 48 hrs after last dose. Severe vomiting, to the point of possible rupture of the esophagus Sulfa Drugs sodium valproate = Depakote

isoniazid cimetidine =Tagamet alcohol binge drinking chloramphenicol erythromycin sulfonamides ciprofloxacin= Cipro omeprazole= Prilosec metronidazole=Flagyl ketoconazole fluconazole Antifungal Azoles - ✔✔All are CYP450 Enzyme inhibitors ↑'ed action of over time. Be careful when you use combination of drugs metabolized by CYP450 Enzymes Rifampin Drug to drug interactions - ✔✔ C-dif causes, symptoms, assessment - ✔✔ Plain PCN has covers - ✔✔Gram + bacteria 3rd generation Cephalosporins covers - ✔✔Weak Gram+, Gram - & B Lactamase Which has broadest coverage PCN's or 3rd generation Cephalosporins? - ✔✔3rd generation cephalosporins Which has narrowest coverage PCN's or 3rd generation Cephalosporins? - ✔✔Plain PCN If you wanted to treat a simple condition of gram + strep throat - ✔✔The wise steward would go with plain PCN VK

Would PCN cover Trichomonas Vaginalis, an anaerobic flagellated protozoan? - ✔✔Nope, you would treat it with Metronidazole.