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NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
Maryville University Pharmacology
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
How does carbamazepine work? - ANSWER Works by decreasing nerve impulses that cause seizures and pain
How often should carbamazepine lab values be monitored? What labs? - ANSWER CBC q 3-4 months
What anti-seizure med auto induces metabolism? - ANSWER Carbamazepine
What medication decreases the production of RBCs, WBCs, and platelets? - ANSWER Carbamazepine
What is carbamazepine half-life? - ANSWER Single dose: 30 hours
Multiple dose: 15 hours
What is a great risk of seizure potential while taking anti-seizure medications? - ANSWER Stopping the medication abruptly.
What type of medication is topiramate (Topamax)? - ANSWER Anti-seizure med
What does topiramate cause? - ANSWER Electrolyte imbalance -- hyperchloremic metabolic acidosis
What are adverse effects of topiramate? - ANSWER Weight loss, high temperature, and inability to sweat
Commented [K1]:
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What medication affects Lamictal? - ANSWER OCPs decrease the effects of this drug, so the dose must be doubled
Can valproate (Depakote) be used during pregnancy? - ANSWER It is a known teratogen. If needed, must be used after 1st trimester.
What must be ruled out in patients before starting an anti-depressant? - ANSWER hypothyroidism
Anti-depressant that is to be used with caution in cardiac patients due to behaving like class 1 anti- arrythmics? - ANSWER TCAs
TCA side effects are mainly of what type? - ANSWER Anti-cholinergic
What is a first-line antidepressant in children? - ANSWER fluoxetine (Prozac)
How do you discontinue an SSRI? - ANSWER Taper by reducing the dose by 50% for 3-4 days
When are MAOIs effective? - ANSWER In atypical depression or Parkinson's
Why are MAOIs reserved for last line of treatment? - ANSWER Lethal drug interactions and food interactions
How long before starting a new antidepressant after MAOIs? - ANSWER At least 2 weeks to clear it from system
What are high tyramine foods and when are they contraindicated? - ANSWER Fermented foods; aged cheese, wine alcohol
Contraindicated with MAOI use
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What anxiolytic has the greatest risk for dependence and resistance? - ANSWER alprazolam (Xanax)
What anxiolytic is first line treatment for panic disorder? - ANSWER diazepam (Valium)
What are characteristics of serotonin syndrome? - ANSWER nausea, diarrhea, sweating, hyperthermia, myoclonic jerking, tremor, agitation, disorientation, HTN, delirium, death
What medication is approved for depression with low energy? - ANSWER venlafaxine (Effexor) (SNRI)
How does Lithium act as a mood stabilizer? - ANSWER It replaces sodium during depolarization so it stops the transmission of electrical impulses
What is important patient teaching for Lithium? - ANSWER Eat a diet with consistent levels of salt because the medication can interfere with the cell sodium channels
Does Lithium have a broad or narrow therapeutic range? - ANSWER Narrow therapeutic range; toxicity may show nausea and drowsiness
How does phentermine work? - ANSWER Treats obesity by decreasing the hunger perception and releases NE an EPI which breaks down stored fat = lose weight
How long is treatment with phentermine? - ANSWER 6 months; loses effects after that
What is important when taking phentermine? - ANSWER DO NOT take with SSRIs or St. John's wort because of increased risk of serotonin syndrome
How should zolpidem (Ambien) be administered? - ANSWER Just before bed because it has a rapid onset
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What antibiotics target or inhibit the cell wall? - ANSWER PCN, cephalosporins, vancomycin
How does antibiotic resistance occur? - ANSWER 1. Natural by genetic mutations
- Spontaneous by random mutations
- Build up over time or by misuse of antibiotics
These antibiotics inhibit bacterial cell wall synthesis or KILL bacteria. - ANSWER Bactericidal antibiotics
These antibiotics suppress bacterial growth and also rely on the immune system to remove the bacteria from the body. - ANSWER Bacteriostatic antibiotics
Which antibiotics contain the beta-lactam ring which allows them to inhibit PBPs in the bacteria? - ANSWER Beta-Lactams (PCNs, cephalosporins, carbapenems, monobactems)
What is beta-lactamase? - ANSWER It is an enzyme that is produced by some bacteria that inactivates some antibiotics.
Are PCNs bactericidal or bactriostatic? - ANSWER Bactericidal
What doe PCN-beta-lactame inhibitor combos do? - ANSWER They make the antibiotics stronger and more effective because they work against the beta-lactamase enzyme that is trying to inactivate the antibiotic; they increase the spectrum of action
Are cephalosporins bactericidal or bacteriostatic? - ANSWER Bacteriocidal
Do cephalosporins become more broad or narrow in spectrum as you go up in generation? - ANSWER More broad spectrum
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What is vancomycin used for? - ANSWER MRSA
Vancomycin peak and trough levels: for who and why? - ANSWER Vancomycin is excreted unchanged by the kidneys; caution in elderly and renal insufficiency patients
What is a serious adverse effect of vancomycin? - ANSWER Red Man Syndrome
Which antibiotics target DNA replication? - ANSWER Fluoroquinolones and sulfonamides
How would you describe fluoroquinolones? - ANSWER Bacteriocidal and BROAD spectrum
What are fluoroquinolones used for? - ANSWER Serious infections; hospital or community acquired infections
What is the black box warning for fluoroquinolones? - ANSWER Tendonitis and tendon rupture in all age groups; especially in Achille's tendon
What medication does fluoroquinolones enhance the effects of? - ANSWER Warfarin; increases bleeding risk because it interacts with the CYP450 system
Why are fluoroquinolones avoided in children and pregnancy? - ANSWER They can inhibit bone growth and they are bad for tendons
When is the risk for tendon rupture the greatest with use of fluoroquinolones? - ANSWER 1. transplant patients
- recent corticosteroid use
- advanced age
- increased quinolone doses
NURS-615 Exam 2 ALL 149 COMPLETE
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Are sulfonamides bacteriocidal or bacteriostatic? - ANSWER Bacteriostatic
If there an an allergy to sulfonamides, which other drugs should be avoided because they are developed from the sulfonamide drugs? - ANSWER Sulfonylureas, thiazide diuretics, loop diuretics
What is sulfasalazine used for? - ANSWER RA, Crohn's, ulcerative colitis, inflammatory disorders
When should you avoid Sulfa medications? - ANSWER In patients with G6PD
What are side effects of sulfonamides? - ANSWER Kernictus (think bilirubin an brain damage), urinary tract disorders, hematopoietic disorders
How and when is silver sulfadiazine used? - ANSWER Used for burns, but its usefulness is poor
What antibiotics block protein productioN? - ANSWER tetracyclines, macrolides, aminoglycosides, lincosamides
Are tetracyclines bacteriostatic or bacteriocidal? - ANSWER bacteriostatic
Why do you not take antacids with tetracyclines? - ANSWER tetracylines have a high affinity to form chelates with metal cations with iron, magnesium, aluminum, and calcium and they inactivate the medication
Are tetracyclines broad or narrow in spectruM? - ANSWER Broad and they have a lot of resistance issues
Why no use of tetracyclines in children and pregnancy? - ANSWER They can stain developing teeth in fetus and up to 8 years old and they inhibit bone growth in children
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What is the greatest risk of clindamycin? - ANSWER C. Diff
What type of antibiotics are macrolides? - ANSWER Block protein production; bacteriostatic; resistance issues
What medication is used for strep throat when there is a PCN allergy? - ANSWER erythromycin; 30 to 50mg/kg/day every 6-8 hours
What is a side effect of erythromycin? - ANSWER GI distress (which is why it is used for ileus)
How is clarithromycin excreted? - ANSWER It is excreted by BOTH the liver and the kidneys so dose adjustments are not required in patients with impaired liver function
What is rifampin used for and what type of antibiotic is it? - ANSWER Of the erythromycin group; used for TB, legionella, leprosy
Is rifampin bacteriocidal or bacteriostatic? - ANSWER Bacteriocidal
What is an adverse effect of rifampin? - ANSWER It turns tears, pee, saliva, and sweat red/orange in color
Is rifampin used in pregnancy? - ANSWER It is used in pregnancy for treatment of TB, but its safety is unknown
What lab values must be tested before long term treatment of rifampin? - ANSWER CBC and liver function studies
NURS-615 Exam 2 ALL 149 COMPLETE
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How does ethambutol work as an anti-TB drug? - ANSWER It inhibits the sythesis of mycelic acids which is an important part of the cell wall
How should ethambutol be used? - ANSWER Never should be used as monotherapy; used with INH, rifampin, or PZA
What is a main side effect of ethambutol? - ANSWER EYES - optic neuritis -- do not use in children under 6
Red/green color blindness, inform immediately as it could be permanent
What is the first line treatment for prevention and treatment of TB and a POTENT bactericidal drug? - ANSWER Isonazid (INH)
How do anti-TB drugs work? - ANSWER They inhibit the formation of mycolic acids which are an important part of the cell wall
What are the liver effects associated with INH? - ANSWER Increase in liver enzymes that is usually harmless and an uncommon effect of liver inflammation -- Liver function should be monitored in all people receiving therapy
What is another main side effect of INH? - ANSWER Peripheral neuropathy (inflammation of nerves causing numbness in arms and legs)
What vitamin decreases peripheral neuropathy associated with INH? - ANSWER pyridoxine (Vitamin B6)
How does pyrazinamide (PZA) act on bacteria? - ANSWER It is largely bacteriostatic, but can be bacteriocidal in actively replicating bacteria
What is the most dangerous side effect of PZA? - ANSWER Hepatotoxicity (dose-related); not possible to distinguish PZA-induced hepatitis from hepatitis caused by INH and rifampin --> test dosing is required
NURS-615 Exam 2 ALL 149 COMPLETE
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When is the polyene anti fungal amphotericin B used? - ANSWER For serious infections due to its side effects
What type of anti-fungal is nystatin that is used for Candida species on the skin and mucous membranes? - ANSWER Polyene anti-fungal
What is the mechanism of action of triazole anti-fungals? - ANSWER They inhibit a critical enzyme that causes a buildup of a toxic substance, this causes the cell to leak out
What is the black box warning for oral ketoconazole? - ANSWER It can causes severe liver injuries and adrenal gland problems
When is oral ketoconazole used? - ANSWER it is never used as first line treatment for any fungal infection; only for endemic mycoses when alternative antifungals have failed
What lab values should be monitored during ketoconazole use? - ANSWER Liver function; many azoles are metabolized by the CYP450 enzymes
What are the imidazole anti-fungals and when are they used? - ANSWER ticonazole (monistat-1), econazole (spectazole), miconazole (ministat, lotrimin), clotrimazole
Used for vulvovaginal canadiasis, oropharyngeal canadiasis, and tinea infections
What is hypochlorhydria? - ANSWER A state in which production of hydrochloric acid in gastric secretions is low or absent
What do "azole" anti-fungals require for absorption? - ANSWER ACID
What should "azole" anti-fungals NOT be administered with? - ANSWER H2 Blockers or Protein pump inhibitors
NURS-615 Exam 2 ALL 149 COMPLETE
SOLUTIONS AVAILABLE.
What type of anti-fungal is terbinafine and what is it used for? - ANSWER An allylamine anti-fungal highly effective against dermatophyte infections (not much against Candida)
What are the side effects of terbinafine? - ANSWER MANY side effects; skin, GI, and liver toxicity (LFTs must be monitored)
What medications are used for parasitic worms and intestinal parasites? - ANSWER mebendazole
agromectin
ivermectin
What medications are used for scabies and lice? - ANSWER Ivermectin and permethrin cream
What type of medication is metronidazole (Flagyl) and what are its characteristics? - ANSWER 1. Antibiotic and anti-protazoal
- It is bacteriocidal and BROAD spectrum
What is metronidazole used for? - ANSWER PID, endocarditis, bacterial vaginosis, giardiasis, trichomonad, amebiasis
What is the drug of choice for the first episode of mild-moderate C. Diff? - ANSWER Metronidazole (Flagyl)
What should not be ingested with metronidazole (Flagyl)? - ANSWER Alcohol -- causes a disulfiram-like reaction
What is a disulfiram-like reaction? - ANSWER N/V, flushing of skin, tachycardia, SOB
