220 Flashcards
Bactericidal vs. Bacteriostatic
Bactericidal- Kill bacteria.
Bacteriostatic- Slows growth of bacteria.
What another class of Abx must be avoided if client has a severe allergy to penicillins?
A. Cephalosporins
B. Fluoroquinolones
C. Sulfonamides
D. Macrolides
A. Cephalosporins.
Why is it important for pts with DM or on dialysis to be monitored while on penicillins? SATA.
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
A. Hyperkalemia.
C. Hypernatremia.
Why must we monitor ECG changes on pts taking penicillins?
A. At risk for torsades des pointes.
B. At risk for hyperkalemia.
C. At rsk for QT prolongation/ arrhythmias.
D. At risk for hypokalemia and hypomagnesemia.
B. At risk for hyperkalemia.
In which pt should a nurse pay the most attention to when giving cephalosporins?
A. A pt with a Hx of respiratory tract infection.
B. A pt with hypoprothrombinemia.
C. A pt with plans to go to a tropical country.
D. A pt with narrow-angled glaucoma.
B. A pt with hypoprothrombinemia.
- Cephalosporins decreases prothrombin levels.
Cephalosporins are known to be harsh on what organs? SATA
A. Kidneys
B. Lungs
C. Ears
D. Liver
A. Kidneys.
B. Liver.
Which antibiootic is most likely to cause disulfiram (Antabuse)- like reaction with alcohol?
A. Penicillins
B. Cephalosporins
C. Aminoglycosides
D. Anti-mycobacterial such as Rifampin
B. Cephalosporins.
A nurse is providing information about the prescribed doxycycline? Which pt requires further teaching?
A “It is important to take additional birth control method as it will decrease the effectiveness of my oral contraceptives.”
B. “I will be sure to wear sunscreen even if I am going to be outside for several minutes.”
C. “I will be taking them with a full meal as doxycycline is known to cause GI bleeding and increased risk of peptic ulcer.”
D. “This antibiotic may decrease the acnes on my face.”
E. “This antibiotic may discolour my teeth.”
C. “I will be taking them with a full meal as doxycycline is known to cause GI bleeding and increased risk of peptic ulcer.”
-Tetracyclines must always be taken on an empty stomach.
Which macrolide may produce the most harm in the liver?
A. Azithromycin
B. Clarithromycin
C. Gentamicin
D. Erythromycin
D. Erythromycin.
A heart disease may be exacerbated by which antibiotic family?
A. Cephalosporins
B. Aminoglycosides
C. Macrolides
D. Carbapenems
C. Macrolides.
Which order should you question the most with regards to aminoglycosides? SATA
A. A pt with concurrent use of furosemide.
B. A pt who has a Hx of allergic reaction to penicillins.
C. A pt with a history of liver cirrhosis.
D. A pt with concurrent use of high dose NSAIDs.
A. A pt with concurrent use of furosemide.
D. A pt with concurrent use of high dose NSAIDs.
-Aminoglycosides have a high potential for ototoxicity, nephrotoxicity, and neuromuscular blockage (respiratory paralysis).
Which abx has the same equivalency of IV to PO?
A. Gentamicin
B. Amoxcillin
C. Doxycycline
D. Isoniazid
E. Ciprofloxacin
F. Piperacillin-Tazobactam
E. Ciprofloxacin.
-Fluoroquinolones -> IV=PO.
Fluoroquinolones are contraindicated to or must be cautioned to which pts? SATA
A. A 15 yr old M taking ciprofloxacin.
B. A 28 yr old runner.
C. A 35 yr who is breastfeeding.
D. A 45 yr M taking norfloxacin.
E. A geriatric pt with QT prolongation.
All
-Fluoroquinlones may cause tendon ruptures, can cross into breast milk, may cause photosensitivity and QT prolongation/ arrhythmias.
Which pt can use sulfonamide drugs? SATA
A. A pt with a possibility of pregnancy.
B. RA
C. UC
D. UTI
E. A pt with a Hx of allergic reaction to celecoxib.
F. A pt with a Hx of allergic reaction to penicillin.
G. A pt with agranulocytosis or thrombocytopenia.
H. A pt with a Hx of OSA.
I. A pt with kidney stones.
B. RA
C. UC
D. UTI
F. A pt with a Hx of allergic reaction to penicillin.
I. A pt with kidney stones.
-Sulfonamides have anti-inflammatory effects.
Which abx family can cause photosensitivity?
Tetracyclines, Fluoroquinolones, Sulfonamides
Which are true about Vancomycin? SATA
A. Nephrotoxic
B. Hepatotoxic
C. Ototoxic
D. Causes confusion/ hallucination.
E. Causes red man syndrome.
F. Treats VRE.
G. Treats MRSA.
A. Nephrotoxic.
C. Ototoxic.
D. Causes confusion/ hallucination.
G. Treats MRSA.
Which abx family decrease effectiveness of OCP?
Tetracyclines, Sulfonamides
CBO/CBE are resistant to what class of abx?
Carbapenems.
ESBLs are resistant to what class of abx?
Penicillins and cephalosporins
MRSA will not respond to what class of abx? FMAT***
Fluoroquinolones, macrolides, aminoglycosides, or tetracyclines.
What is not true about fungal infections?
A. They are not easily transmissable.
B. More common in immunocompromised pts.
C. Systemic fungal infections may be rapidly fatal.
D. Fungal infections take less time to treat, as it is easier to treat than bacterial infections.
D. Fungal infections take less time to treat, as it is easier to treat than bacterial infections.
What is true about superficial fungal infection? SATA
A. Superficial antifungal drugs interact with a lot of drugs and must be contraindicated with people with hepatotoxicity
B. Avoiding occlusive dressing or ointment on moist, dark areas of the body to prevent superficial fungal infection.
C. Amphotericin B is used for superficial fungal infection.
D. Educate pt to avoid sharing shoes, towels, or personal objects.
B. Avoiding occlusive dressing or ointment on moist, dark areas of the body to prevent superficial fungal infection.
D. Educate pt to avoid sharing shoes, towels, or personal objects.
What drug is known to treat superficial fungal infection such as jock itch, athlete’s foot, and ringworm; as well as fungal infections of scalp, fingernails, and toenails? This drug is used PO and ineffective topically.
Griseofulvin.
What are some of the common side effects of griseofulvin? SATA
A. Phototoxicity
B. SJS
C. Urticaria
D. Dizziness
E. Decreased effectiveness of OCPs
F. Disulfiram-like reaction to alcohol
G. Hypovolemia
H. Syncope
All except G and H.
What must be done first if a pt with DM is not feeling well?
Check blood glucose.
Which medication can block the signs of hypoglycemia?
A. Ramipril
B. Glyburide
C. Canaglifozin
D. Labetalol
E. Atorvastatin
D. Labetalol, a beta-blocker
Which of the following is not a rapid-acting insulin?
A. Detemir
B. Lispro
C. Glulisine
D. Aspart
A. Levemir, long-acting.
Onset, peak, and duration of rapid-acting insulin.
Onset: <15 min.
Peak: 0.5-1 hr.
Duration: 3-4 hr.
Which of the following pt tells the nurse that the pt was provided the right information?
A. I will administer my Aspart half an hour to an hour after eating a meal.
B. I will administer my Aspart half an hour to an hour before eating a meal.
C. I will administer my Aspart when my BGL is 3.5 mmol/L.
D. My parenteral feed contains Aspart, so it is important to not stop unless ordered.
B. I will administer my Aspart half an hour to an hour before eating a meal.
Onset, peak, and duration of short-acting insulin.
Onset: 0.5-1 hr.
Peak: 2-3 hr.
Duration: 8 hr.
The pt should eat ___.
A. 30 min before administration of regular insulin.
B. 3-4 hr before administration of aspart.
C. 30 min after administration of regular insulin.
D. 3-4 hr after administration of aspart.
C. 30 min after administration of regular insulin.
IV insulin is only indicated for?
A. HHS
B. DKA
C. Both DKA and HHS
D. Neither, used ONLY for hyperkalemia
C. Both DKA and HHS.
What kind of insulin can only be through IV?
Regular
What kind of insulin is used for pregnancy?
Regular only.
Onset, peak, and duration of NPH.
Onset: 1-2 hr.
Peak: 4-12 hr.
Duration: 18-24 hr.
Which type of insulin must not be mixed with anything?
Long-acting: Glargine and Detemir
Onset, peak, and duration of glargine (Lantus).
Onset: 1 hr.
Peak: None.
Duration: 10-24 hr.
(Serious) adverse reactions of insulin. SATA.
A. Irritation at injection site or lipodystrophy.
B. Weight gain
C. Hypoglycemia
D. Severe hyperglycemia
E. Rebound hyperglycemia
F. Hypokalemia
G. Hyponatremia
H. Hyperkalemia
I. Hypernatremia
A. Irritation at injection site or lipodystrophy.
B. Weight gain
C. Hypoglycemia
E. Rebound hyperglycemia
F. Hypokalemia
What are the steps of mixing insulin?
Inject air into cloudy solution, then clear.
Draw clear first, then cloudy.
Hypoglycemia vs. Hyperglycemia
1. Increased hunger
2. Increased HR
3. Increased thirst
4. Diaphoresis
5. Increased urination
6. Sudden change in LOC
1, 3, 5: Hyperglycemia
2, 4, 6: Hypoglycemia
OHAs should not be given to what type of DM?
T1DM.
What organ must be monitored in a regular basis when taken OHA?
Liver.
Which OHA must not be given to those who are pregnant or breast feeding as well as those with renal or liver disease?
A. Metformin
B. Glyburide
C. Canagliflozin
D. Acarbose
B. Glyburide, SULFonylureas.
How does sulfonylureas work in the body?
A. Stimulates gluconeogenesis.
B. Decreases absorption of glucose from the intestine.
C. Stimulates insulin release from pancreas.
D. Turns glucose into water and CO2.
C. Stimulates insulin release from pancreas.
In which situation should we question an order for glyburide? SATA.
A. A pt has a Hx of allergic reaction to hydrochlorothiazide.
B. A pt has a Hx of allergic reaction to sulphasalazine.
C. A pt currently taking furosemide.
D. A pt currently taking other OHAs as prescribed.
E. A pt has a Hx of allergic reaction to ASA.
A. A pt has a Hx of allergic reaction to hydrochlorothiazide.
B. A pt has a Hx of allergic reaction to sulphasalazine.
What is the only biguanide drug in the market?
A. Metformin
B. Metronidazole
C. Mefenamic Acid
D. Metoprolol
A. Metformin.
How long does biguanide take to reach ts therapeutc effect?
6-12 wk.
What OHA is needed to be held 48 hr prior and 48 after a pt needs contrast dye?
Biguanide- Metformin.
Who should not get Metformin or who should the nurse pay the most attention to when prescribed Metformin? SATA.
A. Impaired renal function.
B. Heart, liver, and kidney failure.
C. Hx of lactic acidosis.
D. Severe COPD.
E. Hyperglycemia T2DM.
F. Hypoglycemia.
G. Concurrent serious infection.
H. Hypothyroidism.
I. Pregnancy.
All except E and H.
Which OHA family is closely related to sulfonylureas and has a high risk for hypoglycemia?
Meglitinides.
Alpha-glucosidase inhibitors primarily work in what organ system?
GI.
Which OHA increases insulin sensitivity, transport, and utilization at target tissues as their primary MOA? Last name -glitazones.
Thiazolidinediones.
Which OHA families work on incretin hormones?
DPP-4 inhibitors (e.g. Sitagliptin) and GLP-1 agonists (e.g. Semaglutide).
2 classification of adrenergic agonists.
Catecholamines and noncatecholamines.
What is true about catecholamine drugs?
A. They are usually long-acting.
B. Destroyed rapidly by MAO and COMT.
C. Usually taken by mouth for better absorption, especially in the small intestine.
D. Crosses easily in the BBB.
B. Destroyed rapidly by MAO and COMT.
Match
1. Alpha-1
2. Alpha-2
3. Beta-1
4. Beta-2
5. Beta-3
A. Lungs and uterus.
B. Adipose tissues, skeletal muscle, bladder, and gallbladder.
C. For HTN, non-autonomic.
D. For nasal congestion and producing mydriasis.
E. Heart.
- D.
- C.
- E.
- A.
- B.
What must be considered when it comes to epinepherine?
A. Monitor fo hypoglycemia.
B. Store in fridge, do not freeze.
C. Must not be given in severe shock.
D. Store in a dark place.
D. Store in a dark place.
What are some contraindications/ precautions to using phenylephrine? SATA.
A. Severe HTN.
B. Severe hypotension.
C. Advanced CAD.
D. Severe ototoxicity.
E. Use of nitroglycerin.
F. Narrow-angle glaucoma.
G. Hypothyroidism.
H. Hyperthyroidism.
I. DM.
J. Hypoglycemia.
K. Preexisting bradycardia.
L. Preexisting tachycadia.
A, C, E, F, H, I, K.
What are some important considerations for alpha-1 agonists? SATA.
A. Acetylcysteine is the antidote.
B. Dermatotoxicity is common, so use sunscreen.
C. Remove contact lenses after administration.
D. Avoid caffeine.
E. Contact HCP if weakness, tiredness, or low energy occurs.
C and D. Phentolamine is the antidote and must contact HCP if jittery or nervouusness.
Adverse effects of anticholinergics.
Agitation (Increased HR and BP)
Blurred vision
Constipation and confusion
Dry mouth
Stops urine and sweat
Belladonna is a natural source of alkaloids with ___?
A. Cholinergic activity
B. Anticholinergic activity
C. Insulin activity
D. Antibacterial activity
E. Antifungal activity
B. Anticholinergic activity.
What is muscarinic antagonists used for? SATA.
A. IBS.
B. Bronchodilation to asthma and COPD.
C. Antidotes for poisoning or OD.
D. For urge incontinence.
E. Alzheimer’s.
F. Parkinson’s.
All except E.
Which is not an adverse effect of muscarinic antagonist?
A. Urinary retention.
B. Xerostomia.
C. Bradycardia.
D. Photophobia.
C. Bradycardia.
What is the antidote for anticholinergic such as belladonna?
A. Phentolamine
B. Acetylcysteine
C. Physostigmine
D. Isoproterenol
C. Physostigmine.
Nicotinic antagonists: ganglionic blockers are used for what?
A. Vasodilation
B. Vasoconstrion
C. Reduced insulin sensitivity
D. Hyperglycemia
A. Vasodilation
Depolarizing vs. Nondepolarizing neuromuscular blockers.
Depolarizing: Given to produce muscle paralysiss during short med-surg procedures.
Nondepolarizing: For longer procedures.
Succinycholine is a?
A. Depolarizing nicotinic antagonists: neuromuscular blockers.
B. Nondepolarizing nicotinic antagonists: neuromuscular blockers.
C. Catecholamine: adrenergic agonists.
D. Noncatecolamine: adreneric agonists.
E. Non-selective alpha agonists.
F. Non-selective beta agonists.
A. Depolarizing nicotinic antagonists: neuromuscular blockers.
Tubocararine is a?
A. Depolarizing nicotinic antagonists: neuromuscular blockers.
B. Nondepolarizing nicotinic antagonists: neuromuscular blockers.
C. Catecholamine: adrenergic agonists.
D. Noncatecolamine: adreneric agonists.
E. Non-selective alpha agonists.
F. Non-selective beta agonists.
B. Nondepolarizing nicotinic antagonists: neuromuscular blockers.
Succinylcholine is successful when?
A. Breathing slows down.
B. Breathing fastens.
C. Muscle contraction occur.
D. Restlessness occur.
C. Muscle contraction occur.
Succinylcholine is not successful when?
A. Breathing slows down.
B. Breathing fastens.
C. Muscle contraction occur.
D. Restlessness occur.
D. Restlessness occur.
Tubocararine produce muscle contraction or paralysis?
Paralysis.
Succinylcholine induces relaxation in less than ___?
A. 240 min
B. 60 min
C. 15 min
D. 1 min
D. 1 min.
Succinylcholine (serious) adverse effects. SATA.
A. Respiratory paralysis/ depression
B. Tachycardia
C. Hypotension
D. Overactive bladder
E. Malignant hypothermia
F. Dysrhythmias
G. Bradycardia
H. Hypertension
I. Cardiac arrest for children with congenital MSKL disease.
A, B, C, F, and I.
Does tubocurarine cause sedation? analgesia, or LOC?
No. Must use benzos, propofol, and opioids.
What is not true about first-dose phenomenon?
A. When sympathetic nervous system is blocked, parasympathetic predominates.
B. (Orthostatic) hypotension can occur.
C. Prevention by initial therapy begun with low doses and usually given in the morning.
D. Reflex tachycardia and nasal congestion occur.
C. Prevention by initial therapy begun with low doses and usually given in the morning. Given at bedtime due to orthostatic hypotension.
What is true about selective alpha-1 blockers?
A. It is a catecholamines.
B. Blocks both arterioles and veins.
C. Cannot be mixed with diuretics.
D. Contraindication is BPH.
B. Blocks both arterioles and veins.
Which is safer for pts with COPD, selective or non-selective beta blockers?
Selective.
What other drug family can potentiate HF with beta-blockers?
A. NSAIDs
B. Loop diuretic
C. CCB
D. OCP
C. CCB.
Why must beta blockers not be stopped abruptly?
Rebound cardiac excitation.
Beta-blockers are dangerous in which condition? SATA.
A. DM
B. COPD
C. HTN
D. Glaucoma
A. DM -> Masks s/s of hypoglycemia.
B. COPD -> Causes bronchoconstriction.
What is not true about considerations of propranolol?
A. Monitor VS q15min-1h.
B. Educate regarding reducing calcium intake.
C. Examine pt for impaired circulation such as IRR, SOB, BLE edema.
D. Monitor for widening of QRS.
B. Educate regarding reducing calcium intake. Reduce sodium intake instead.
When should metoprolol be held? SATA.
A. HR is more than 100 bpm.
B. HR is less than 60 bpm.
C. SBP is more than 160 mmHg.
D. SBP is less than 100 mmHg.
A. HR is more than 100 bpm.
C. SBP is more than 160 mmHg.
What is not true about considerations of metoprolol?
A. Always contact HCP if holding.
B. Watch for symptoms of depression.
C. Watch for masked hypothyroidism.
D. Watch for masked hypoglycemia.
E. Watch for depression.
C. Watch for masked hypothyroidism. Watch for maskedd hyperthyroidism.
Alpha antagonists decrease peripheral resistance and ___.
CCBs decrease ___.
(Afterload or preload).
AA: Preload.
CCB: Afterloa
CCBs produce a negative ___ and ___ effect.
Inotropic (contraction).
Chronotropic (rate).
Which of these is not an antidote for nifedipine?
A. Dopamine
B. Dobutamine
C. Calcium infusions
D. Prazosin
D. Prazosin.
Nifedipine increase the serum level of ___ which can cause bradycardia.
A. Digoxin
B. Norepinepherine
C. Succinylcholine
D. Warfarin
A. Digoxin
In which drug can gingival hyperplasia occur with and must be reported?
A. Propranolol
B. Nifedipine
C. Piperacillin
D. Erithromycin
B. Nifedipine
What is not true about verapamil?
A. Increases digoxin levels with increase risk of bradycardia.
B. Increases buspirone concentration by 3x.
C. Risk of myopathy with catecholamines.
D. Neurotoxicity with carbamazepine.
E. Grapefruit juice increases levels of the drug.
C. Risk of myopathy with catecholamines. With statins.
What is not true about verapamil? SATA.
A. Withhold drug if SBP <90 or symptomatic.
B. Keep pt. on high fowler’s for at least an hour.
C. Monitor for HTN with digoxin use.
D. Monitor on telemetry continuously if parenteral.
B. Keep pt. on high fowler’s for at least an hour. Recumbent**
C. Monitor for HTN with digoxin use. Monitor for heart block or bradycardia
What nonhydropiridine CCB is used off-label for migraine?
Diltiazem
