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NU 641 Advanced Pharm (for NPs) Vaccines
Achieve Excellence: Expert-Verified Questions
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What type of infections do gram-positive cocci cause? A. Respiratory infections B. Staph skin infections, endocarditis, group A strep, UTIs C. Gastrointestinal infections D. Fungal infections Correct Answer: B. Staph skin infections, endocarditis, group A strep, UTIs Rationale: Gram-positive cocci, such as Staphylococcus and Streptococcus, are known to cause skin infections, endocarditis, group A strep, and urinary tract infections.
- What is the first-line treatment for an adolescent female with a urinary tract infection (UTI)? A. Amoxicillin B. Nitrofurantoin (Macrobid) C. Azithromycin D. Tetracycline Correct Answer: B. Nitrofurantoin (Macrobid) Rationale: Nitrofurantoin is commonly used as the first-line treatment for uncomplicated UTIs in adolescents due to its effectiveness against urinary pathogens.
- A child presents with uncomplicated UTI symptoms that resolve after 24 hours of treatment. This is an example of: A. Antimicrobial efficacy B. Antibiotic resistance C. Drug hypersensitivity D. Immune response
Correct Answer: A. Antimicrobial efficacy Rationale: The resolution of symptoms after starting treatment indicates the effectiveness of the prescribed antibiotic, demonstrating antimicrobial efficacy.
- A patient in her first trimester of pregnancy presents with symptoms of a UTI. What drug can be used to treat her? A. Sulfamethoxazole B. Amoxicillin C. Fluoroquinolones D. Tetracyclines Correct Answer: B. Amoxicillin Rationale: Amoxicillin is safe during pregnancy, and if the infection is resistant to amoxicillin, nitrofurantoin may be used. Sulfa drugs, fluoroquinolones, and tetracyclines are contraindicated during pregnancy.
- What antibiotics are not safe for women in pregnancy? A. Penicillins B. Cephalosporins C. Fluoroquinolones, tetracyclines, or sulfa drugs D. Macrolides Correct Answer: C. Fluoroquinolones, tetracyclines, or sulfa drugs Rationale: These antibiotics are contraindicated during pregnancy due to risks of fetal harm, including developmental toxicity and teratogenicity.
- What is the pre-operative antibiotic of choice? A. Amoxicillin B. Cefazolin (Ancef) C. Clindamycin D. Azithromycin Correct Answer: B. Cefazolin (Ancef) Rationale: First-generation cephalosporins, like cefazolin, are commonly used as prophylactic antibiotics before surgery to prevent infection.
- How do beta-lactam antibiotics work? A. Inhibit protein synthesis B. Inhibit cell wall synthesis C. Disrupt DNA replication D. Increase cell permeability Correct Answer: B. Inhibit cell wall synthesis Rationale: Beta-lactam antibiotics, including penicillins and cephalosporins, inhibit bacterial cell wall synthesis, leading to bacterial cell death.
- How do bacteriostatic antibiotics work? A. Inhibit cell wall synthesis B. Inhibit bacterial protein activity C. Disrupt bacterial DNA D. Increase bacterial membrane permeability Correct Answer: B. Inhibit bacterial protein activity Rationale: Bacteriostatic antibiotics, such as tetracyclines and macrolides, work by inhibiting bacterial protein synthesis, preventing bacterial growth.
- A parent presents with symptoms of sinusitis and currently has a child in daycare. What drug would be the first-line treatment? A. Amoxicillin B. Amoxicillin/clavulanate C. Ceftriaxone D. Ciprofloxacin Correct Answer: B. Amoxicillin/clavulanate Rationale: In patients with potential resistant organisms due to daycare exposure, amoxicillin/clavulanate is preferred for sinusitis treatment.
- A patient presents with a rash after taking PO amoxicillin for several days. What should the provider do? A. Continue the amoxicillin B. Discontinue the amoxicillin
C. Switch to another beta-lactam antibiotic D. Prescribe an antihistamine Correct Answer: B. Discontinue the amoxicillin Rationale: A rash after taking amoxicillin may indicate an allergic reaction, so the medication should be discontinued to avoid further complications.
- What drugs would be effective at treating strep pharyngitis? A. Erythromycin B. Ampicillin, amoxicillin, amoxicillin/clavulanate, and azithromycin C. Ciprofloxacin D. Doxycycline Correct Answer: B. Ampicillin, amoxicillin, amoxicillin/clavulanate, and azithromycin Rationale: These antibiotics are effective for treating strep pharyngitis. Erythromycin is not recommended due to resistance.
- All stages of syphilis are effectively treated with: A. Doxycycline B. Penicillin IM C. Ciprofloxacin D. Amoxicillin Correct Answer: B. Penicillin IM Rationale: Penicillin is the gold standard for treating syphilis in all stages. Alternative treatments can be used if the patient has a penicillin allergy.
- If a patient has tested positive for gonorrhea or chlamydia, what must be done? A. Immediate retesting B. Retest for Test of Cure (TOC) at 3 months and 6 months C. Discontinue all medications D. No further follow-up is needed Correct Answer: B. Retest for TOC at 3 months and 6 months Rationale: Follow-up testing is important for gonorrhea and chlamydia to ensure the infection has been fully eradicated.
A patient recently swam in dirty water and is now at risk of infection with a severe illness. What medication should they be treated with? - CORRECT ANS- - fluoroquinolone A patient is prescribed carbamazepine what labaratory testing will they need? - CORRECT ANS- - periodic CBCs A patient with an extensive history of seizures is now pregnant. Although none of the anti seizure medications are safe in pregnancy what would be the first line treatment? - CORRECT ANS- - levetiracetam (if stopped abruptly can cause seizures) What are the side effects of topiramate? - CORRECT ANS- - raise in body temperature and inhibits sweating What medication would be administered as an antagonist to benzodiazepines (Valium/Xanax)? - CORRECT ANS- - flumazenil What are the goals of migraine therapy? - CORRECT ANS- - relieve headache, avoid medication overuse, decrease impact on the patient's quality of life What is consistent with medication overuse? - CORRECT ANS- - when medication wears off more and more quickly (typically due to overuse) What are some treatments for stress reduction? - CORRECT ANS- - biofeedback, good sleep habits, patient education What is a cluster headache? - CORRECT ANS- - headaches that appear in clusters, usually periorbital, may go months without experiencing any
What condition would you treat with 10-15 minutes of 100% oxygen? - CORRECT ANS- - cluster headaches Guanfacine - CORRECT ANS- - alpha 2 agonist drug used to treat HTN and ADHD What cholinergic drug is used to treat Alzheimer's? - CORRECT ANS- - donepezil Memantine (NMD8 antagonist) is used to treat Alzheimer's disease, this drug is not a ______________. - CORRECT ANS- - cholinesterase inhibitor Why is aricept used more frequently to treat dementia? - CORRECT ANS- - longer duration of activity A 10 year old patient is diagnosed with MDD, what drug would be the first line treatment? - CORRECT ANS- - fluoxetine (prozac), need 4-6 week trial before switching to an alternative agent What are the side effects of SSRIs? - CORRECT ANS- - Agitation, insomnia, headache, nausea and vomiting, sexual dysfunction, weight gain or loss, and hyponatremia Prior to prescribing a patient an anti-depressant what laboratory tests are important to assess? - CORRECT ANS- - thyroid levels Why is the dosing of SSRI's different in men and women? - CORRECT ANS- - men and women metabolize them differently When stopping Sertraline what must be done? - CORRECT ANS- - drug must be tapered due to short half-life, if stopped abruptly could have seizures
What are common side effects of all topical drugs? - CORRECT ANS- - skin irritation, dryness, peeling of skin (if this happens reduce the # of applications per day) What is the iPledge program? - CORRECT ANS- - iPledge is to prevent fatal birth defects when women take a medication under this program. Patient must undergo blood and urine tests once a month to check kidneys and pregnancy. Patient has limited time to pick up medication. If not picked up in time frame, must return to shelf. NO EXCEPTIONS. If this were to occur, patient and doctor must be registered again through the program. Tretinoin (Retin-A) is used for? - CORRECT ANS- - acne and mild wrinkles, not effective with deep wrinkles or sun damaged skin What is the first line treatment for diaper dermatitis? - CORRECT ANS- - 1% topical hydrocortisone Calcipotriol what makes it different than other agents? - CORRECT ANS- - treats psoriasis plaques by reducing the # of cells the skin makes Crisaborole 2% ointment is prescribed to treat atopic dermatitis. How frequently would this medication be used? - CORRECT ANS- - twice daily, can cause burning and stinging at application site A child has impetigo typically caused by MRSA, what should be used for treatment? - CORRECT ANS- - mupirocin How would you treat local skin infections? - CORRECT ANS- - narrow spectrum topical antibiotics
What class of drugs decrease oral contraceptive efficacy? - CORRECT ANS- - antibiotics, antiretrovirals, antiseptic drugs, St, John's Wort When restarting oral contraceptives when do you start? - CORRECT ANS- - 1st day of visit and use backup contraception (condom) for 7 days Why should a patient try to take oral contraceptives at the same time everyday? - CORRECT ANS- - to prevent breakthrough bleeding If transitioning to a different oral contraceptive the new pack would be started? - CORRECT ANS- - at the beginning of the next menstrual cycle A patient is taking both oral contraceptives and hormone replacement therapy. When should they take these medications? - CORRECT ANS- - at the same time to prevent breakthrough bleeding Progestin only type contraceptives can cause? - CORRECT ANS- - irregular bleeding in the first month Antibiotics that do not interact with oral contraceptives? - CORRECT ANS- - ampicillin, clarithromycin, metronidazole, ciprofloxacin, and ofloxacin Where should a patient apply estrogen spray? - CORRECT ANS- - only on the thighs and calves What is a common side effect of hydroxyprogesterone injection? - CORRECT ANS- - depression
An older male patient wants to be prescribed (sildenafil, Tadalafil, Vardenafil) prescriptions must be evaluated - CORRECT ANS- - for use of nitrates that is contraindicated A patient with a history of asthma reports difficulty breathing since starting timolol for glaucoma management. What should provider do? - CORRECT ANS- - d/c timolol and switch to betaxolol Patient reports eye color change from green to brown since starting latanoprost. What should the provider do? - CORRECT ANS- - tell the patient this is a harmless side effect A patient reports to the clinic 3 days after starting treatment with cromolyn. She states "this aren't helping at all." What should the provider do? - CORRECT ANS- - Explain to the patient that it takes several weeks for cromolyn to offer relief, and add H1 receptor antagonist drops (Pataday, Zatidor) What education would be important to include for a patient using any eye drops that wear contact lenses? - CORRECT ANS- - wait 15 minutes after instilling eye drops to put in contact lenses A young mother reports 1 year old tugging on ears and being "fussy" for 3 days. She started using OTC ear drops but as seen no improvement. What should the provider educate the patient on? - CORRECT ANS- - OTC ear drops are for earwax only and not for infection A patient with newly diagnosed hypothyroidism tells you they have been compliant with their levothyroxine and take it every morning at 0600 with other medications and a glass of milk. What education should you provide this patient? - CORRECT ANS- - levothyroxine should be taken with water only an hour before any other medications on an empty stomach Patient frequently misses doses of levothyroxine in the morning. What should the provider discuss with the patient. - CORRECT ANS- - Set an alarm to take medication, do not double
up levothyroxine has a long half-life, maybe consider taking medication at night before bed instead A patient admitted in the hospital reports eating a big breakfast. How long should you wait before administering their levothyroxine. - CORRECT ANS- - instruct patient not to eat again, wait 4 hours A pregnant woman with hypothyroidism is managed with levothyroxine. What can the provider expect will happen to her dose in pregnancy? - CORRECT ANS- - it will increase by up to 30% What drug may increase the effects of warfarin? - CORRECT ANS- - levothyroxine (metabolizes the vitamin K clotting factors) A patient presents with severe hyperthyroidism. What treatment would the provider anticipate is prescribed? - CORRECT ANS- - radioactive iodine to obliterate the thyroid, levothyroxine for life A patient is pregnant and has recently been diagnosed with graves disease. What medication should the patient be prescribed? - CORRECT ANS- - propyluracil (PTU) A patient is on thyroid medications what should the provider monitor closely? - CORRECT ANS- - WBCs When would Lugol's solution be used and how long will it take to work - CORRECT ANS- - to treat hyperthyroidism, several months Patient recently swam in a lake and now presents with severe ear pain (likely fungal otitis externa). What medication should be prescribed? - CORRECT ANS- - 2% acetic acid TID for 1 week
Antibiotics like amoxicillin-clavulanate or erythromycin. Arthritis drugs like methotrexate or azathioprine. Antifungal drugs Niacin Steroids Allopurinol for gout Antiviral drugs for HIV infection What would be prescribed to treat pernicious anemia? - CORRECT ANS- - B12 IM & folic acid (folic acid not given alone because it masks symptoms) What is the antidote for heparin? - CORRECT ANS- - protamine sulfate What is the antidote for warfarin? - CORRECT ANS- - Vitamin K What electrolytes should be closely monitored when patient is taking digoxin? - CORRECT ANS- - potassium, magnesium, calcium (excess Ca, and low K & Mg make you more susceptible to digoxin) Patient is currently on simvastatin and drinks grapefruit juice everyday. What should you educate the patient on? - CORRECT ANS- - switch to orange juice (compounds can negatively interact from grapefruit) What should a provider do if patient has muscle injury from "statin." - CORRECT ANS- - review other medications pt is taking, consider switching to a different statin What drugs are used to treat a hypertension crisis? - CORRECT ANS- - IV --> nitroprusside, labetalol, esmolol, nicardipine, & fenoldopam
How do loop diuretics work, what are some examples, what labs to monitor? - CORRECT ANS- - how: decrees fluid buildup by reducing sodium reabsorption in the loop of henle med: furosemide (lasix) labs: potassium, sodium, chloride A patient presents with 3+ pitting edema and crackles bilaterally, what would you prescribe? - CORRECT ANS- - loop diuretic (furosemide) What renin inhibitor is used to treat hypertension? - CORRECT ANS- - Aliskiren How do thiazide diuretics work and what are some examples? - CORRECT ANS- - promote diuresis and increase urine flow meds: Chlorothiazide, Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone. What is procaiminide prescribed to treat? - CORRECT ANS- - arrhythmias What is the DASH diet? - CORRECT ANS- - designed to help reduce BP and improve heart health (fruits, vegetables, whole grains, lean proteins, low-fat dairy, reduced sodium, rich in K, Mg, & Ca) An elderly patient is suffering with constipation, what would be the first line treatment? - CORRECT ANS- - bulk forming laxative (methylcellulose) Can a pregnant or breastfeeding woman use a bulk forming laxative to treat constipation? - CORRECT ANS- - yes, this is safe
What medication is used for gout prophylaxis after an acute attack? - CORRECT ANS- - Probenecid What is a provider concern when using local anesthetics like lidocaine? - CORRECT ANS- - heart block Live Attenuated vaccines general principles - CORRECT ANS- - Not administered to immunocompromised patients Usually not given if patient has febrile illness If patient needs two live vaccines: - CORRECT ANS- - Give both the same day OR Administer at least 4 weeks apart Can live attenuated vaccine be administered in pregnancy? - CORRECT ANS- - Not administered in pregnancy Pregnancy should be avoid for 1 month after vaccination Drug interaction with live attenuated vaccine? - CORRECT ANS- - Antiviral drugs List of live attenuated vaccines? - CORRECT ANS- - Live Attenuated Influenza Vaccine (Flumist) Measles, Mumps, and Rubella Vaccine (MMR) Oral Poliovirus Vaccine (OPV) - no longer used in US Rotavirus Vaccine (Rotarix, RotaTeq) Varicella Virus Vaccine (Varivax, ProQuad) Herpes Zoster Vaccine (Zostavax) LAIV (Flumist)
what are the two types of live Attenuated Influenza Vaccine? - CORRECT ANS- - Was trivalent and Quadrivalent (February 2012) 2013 - 2014 flu season only available as Quadrivalent Trivalent - - CORRECT ANS- - Contains 2 strains of Influenza A and 1 strain of influenza B Quadrivalent - - CORRECT ANS- - Contains 2 strains of Influenza A and 2 strains of influenza B How is LAIV (Flumist) administered? - CORRECT ANS- - Administered intranasally (half in each nostril) Live vaccine replicates in nasal mucosa Administer to healthy patients age 2 yrs to 49 yrs annually Children age 2 to 8 years need typically need 2 doses (4 weeks apart) 1st year - refer to guidelines LAIV (Flumist) contraindications? - CORRECT ANS- - Contraindicated: Egg allergy, asthma, immunocompromised, pregnancy, lactation (possibility of viral shed in breast milk) Measles, Mumps & Rubella (MMR) - CORRECT ANS- - 2 doses 99% effective in providing immunity Contraindications for MMR: - CORRECT ANS- - neomycin or gelatin allergy, pregnancy (within 3 months of vaccine), immunosuppression, febrile illness May be given to close contact of immunosuppressed patients Wait 3 months from receiving blood products can MMR be given to pt with egg allergy? - CORRECT ANS- - Ok to give with egg allergy
