Final Exam Q&A Flashcards
What are general contraindications to vaccines?
- Severe reaction, e.g., anaphylaxis, after a previous dose or to a vaccine component
- Vaccines can be given even if egg allergy
What vaccines contraindicated in pregnant women, severe immunodeficiency (e.g., hematologic and solid tumors, chemotherapy, congenital immunodeficiency or long-term immunosuppressive therapy) and in HIV infection (CD4+ count < 200)?
- MMR
- VAR
- HZV
- HPV
- Influenza (LAIV)
- TB
Wha general approaches to management parents who refuse vaccinations for their child?
- Establishing a positive dialogue
- Identifying specific parental concerns
- Providing education targeted to those concerns
- Maintaining a relationship with the family
- Making every effort to follow the recommended immunization schedule
What are non-pharm interventions for scabies & lice?
- Removal nits using specially designed combs after pharm treatment
- Wrap hair in vinegar-soaked towel for 30-60mins
- Launder all personal belongs in hot water
- Soak combs & brushes in disinfectant solution (or rubbing alcohol) or in hot water
What is the first line treament for folliculitis and furuncles?
- Usually self-limiting
- Hot compresses and anti-septic cleaner may be beneficial
- Systemic therapy not generally required
When are live, attenuated vaccines contraindicated?
- Pregnancy
- Severe immunodeficiency (e.g., hematologic and solid tumors, chemotherapy, congenital immunodeficiency or long-term immunosuppressive therapy)
- HIV infection (CD4+ count < 200)
What is the second line treament for folliculitis and furuncles?
Topical therapy in less severe/localized cases
- Mupirocin 2% cream. Apply sparing TID
- Fusidic Acid 2% cream. Apply sparingly TID-QID. If covered with occlusive dressing, then daily or BID
Same 1st line as impetigo & bullous impetigo
What are the 1st and 2nd treament for carbuncles?
Carbuncles-Moderate-Severe (“c” for collection of furuncles and antiobiotics)
- 1st line: Cephalexin 500mg QID
- 2nd line: Cloxacillin 500mg QID OR Clindamycin 300-450mg QID
What is the 1st line and 2nd treatment for cellulitis – Uncomplicated: Mild (Adult & Child)?
- 1st line: Cephalexin 500mg QID; Children: 50-100mg/kg/day divided q6h
- 2nd line: Cloxacillin 500mg QID; Children: 50mg/kg/day divided q6h OR Clindamycin 300mg QID; Children: 25mg/kg/day
- Caused by S. aureus, Group A Strep
What does the post-exposure prophylaxis of immunocompetent persons who have not been previously immunized with rabies vaccine consists of?
- local wound treatment
- rabies immune globulin (20 IU/kg) given on day 0 with as much as possible infiltrated into and around the wound; and
- four 1.0 mL IM doses of rabies vaccine given on days 0, 3, 7 & 14
Post-exposure prophylaxis of persons previously appropriately immunized with rabies vaccine consists of:
- local wound treatment, and
- Two 1.0 mL IM doses of rabies vaccine given on days 0 and 3
- Rabies immune globulin should not be given to persons who have previously received appropriate rabies vaccinations
What are the health teaching for a patient with herpes simplex virus?
- consistent safer-sex practices
- risk of genital herpes from orogenital sex
- Identify barriers to prevention and the means to overcome them
- Genital HSV infection is not curable
- Natural history of the disease, emphasis on recurrent episodes, asymptomatic shedding & sexual transmission
- Antiviral therapy(Valacyclovir) for recurrent episodes may shorten duration of lesions, and suppressive antiviral therapy can ameliorate or prevent recurrent outbreaks
- inform their sex partner(s) that they have genital herpes.
- Have patient and sexual partner(s) get type-specific serologic testing
- Transmission of genital herpes can occur in asymptomatic shedding
- Abstain from sexual activity from the onset of prodromal symptoms until the lesions have completely healed
- Condom use
- Assess patients with genital herpes for other STIs and treat as needed.
- Discuss the risk of neonatal infection with all patients, including men.
- Genital herpes increases the risk of acquisition of HIV twofold
Treatment for herpes zoster should be initiated:
Within 24 hours of symptoms
Within 72 hours of onset of rash
Effective initiated at any time
Only effective for recurrent infections
- Within 72 hours of onset of rash
- Systemic antiviral nucleoside analogues (acyclovir, famciclovir, valacyclovir), initiated within 72 hours of rash onset, reduce the duration of viral shedding, acute pain and the appearance of new lesions
All oral antivirals are effective in reducing the time to healing of orolabial herpes simplex infection?
True
False
- False
- Valacyclovir may be more effective than acyclovir, and both are more effective than famciclovir
Which one of following is a first-line treatment of varicella zoster in an immunocompetent host?
valacyclovir 1000 mg PO TID x 7 days
valaclyclovir 500 mg PO TID x 7 days
gancyclovir 1000mg PO TID x 7 days
Zostrix 3gms topically BID
valacyclovir 1000 mg PO TID x 7 days
Which one of the following is a common side effect of the first-line agent in the treatment of herpes zoster are:
- GI upset and flatulence
- metallic taste and constipation
- rash and fatigue
- nausea and headache
nausea and headache
Which of the following products are recommended in the treatment of pain related to herpes zoster?
- Tylenol
- Ibuprofen
- Gabapentin
- Hydromorphone
- All the above
All the above
Which type of therapy is considered first line in the treatment of comedonal acne?
- Retinoic acid
- Topical retinoid therapy
- Acutane
- Clindamycine po
Topical retinoid therapy
What is the main side effect of topical retinoid therapy?
A) increase number of pimples before seeing improvement
B) greasy skin
C) skin irritation
D) scarring
C) skin irritation
What is the recommended dose of tetracycline as a systemic treatment for acne?
250 mg po daily, then 100mg daily for maintenance.
500 mg po bid, then 250 mg daily for maintenance
1000 mg po bid, then 500mg daily for maintenance
375mg po daily, continue for maintenance
500 mg po bid, then 250 mg daily for maintenance
Which of the following is contraindications of tetracycline?
comedogenic acne
age under 16 years
pregnancy
history of GI upset
pregnancy
Check all of the following that are known side effects of tetracycline:
GI irritation
photosensitivity
intracranial hypertension
rash
photosensitivity
GI irritation
intracranial hypertension
Topical clindamycin and erythromycin, used in combination with benzoyl peroxide, reduces the risk of bacterial resistance.
True or False?
True
What are health care instructions for acne?
- Wash with mild soap, no more than 2-3 times daily
- Avoid manipulation and picking of lesions
- Use water-based and non-scented creams and cosmetics
Which of the following pharmacological therapies is considered first line in the treatment of uncomplicated rosacea?
metronidazole (MetroGel) topical gel 0.75% BID
Isotretinoin (Accutane) 0.5-2mg/kg/day p.o.
Dapsone (Aczone) 5%, topical gel BID
glycolic acid 2–15% (Neostrata) topical gel, BID
metronidazole (MetroGel) topical gel 0.75% BID
Which of the following is the most common side effect of topical metronidazole use?
- local irritation
- numbness
- edema
- alopecia
local irritation
Clients can expect improvement and full therapeutic effect of metronidazole in treating their rosacea within 4-6 weeks of treatment. True or False?
True
Which of the following are effective oral antibiotics used in the treatment of Rosacea (check all that apply)?
- Amoxicillin
- Erythromycin
- Tetracycline
- Doxycycline
- Erythromycin
- Tetracycline
- Doxycycline
Which of the following are health education topics that the NP-PHC should provide to clients when treating rosacea?
sun protection
avoid injury of skin through rough manipulation
consider cosmetic foundation with green tint
identify and avoid triggers
medication side effects, risks and drug interactions
all of the above
all of the above
Which of the following are triggers that clients should when diagnosed with rosacea?
- sunlight or heat
- hot drinks or food
- vinegar-use of astringents
- topical corticosteroids to the face
- alcohol
- spicy foods
- all of the above
all of the above
Which of the following is the first line prophylactic pharmacotherapy for animal and human bites in adults?
- ciprofloxacin 250mg PO QID x 7 days
- amoxicillin-clavulanate 500mg or 875mg PO BID x 3-5 days
- clarithromycin 1000mg PO TID x 10 days
- doxycycline 100mg PO QID x 14 days
amoxicillin-clavulanate 500mg or 875mg PO BID x 3-5 days
Under what circumstances are prophylaxis antibiotics indicated for animal/human bites?
- high-risk wounds to: face, upper limbs, hand, foot, genitalia, over joints/cartilaginous structures
- Moderate-severe tissue damage
- Unprovoked attacks or wild animals
- Those caused by cats-80% of cat bites result in infection
- Usual prophylactic course is 3-5 days
Which of the following choices are commonly implicated in impetigo and folliculitis?
- Hemophilus influenza
- Staphylococcus aureus and pseudomonas folliculitis
- Group B Streptococcus
- Pneumoncoccus
Staphylococcus aureus and pseudomonas folliculitis
Staphylococcus aureus carriage in the anterior nares is a common cause of recurrent impetigo? True or False?
True
Which one of the following is a first line topical treatments for impetigo in children and adults?
- erythromycin 2% cream
- clindamycin 1%
- fusidic acid 2% ointment
- metronidazole .75% gel
fusidic acid 2% ointment
What are the two most common reasons for recurrent impetigo?
- S. aureus carriage in anterior nares or perineum
- Secondard bacterial impetiginization of underlying dematoses such as ecema or psoriasis
Which pharmacological therapy is considered first line in the treatment of a diaper rash?
Topical hydrocortisone 1% ointment plus an antifungal agent if candida is suspected.
Nystatin 100,000 units/ml is the first line pharmacological treatment of oral thrush in an infant. True or False
True
Which of the following is considered first line pharmacological intervention for the treatment of contact dermatitis?
A) topical clindamycin ointment
B) topical antihistamine cream
C) topical corticosteroids
D) xylocaine topical gel
C) topical corticosteroids
What health education should the NP-PHC give a client when treating contact dermatitis secondary to poison ivy exposure? Check all that apply.
A) Wash exposed skin with soap immediately
B) Burn the poison ivy plants
C) Launder exposed clothing in hot water
D) Apply topical cortisone sparingl
A) Wash exposed skin with soap immediately
C) Launder exposed clothing in hot water
D) Apply topical cortisone sparingl
What are interventions for persistent pruritis in patients with scabies?
- emollient creams
- oral antihistamines
- topical corticosteroids
Which age group is at the greatest risk of contracting invasive haemophilus influenzae type B?
Young children between 0 and 2 years of age
Which disease may cause congenital anomalies if a mother contracts it during the first three months of pregnancy?
Rubella
What is the dose of epinephrine for anaphylaxis treatment?
- Epinephrine 1:1000 to administer in cases of anaphylaxis is 0.01 ml/kg to a maximum of 0.5 ml by subcutaneous or intramuscular injection
- Standard dose for adults is 0.3mg; if child is 30 kg or more give 0.3mg
When a person shows the following symptoms—fever, conjunctivitis, Koplik’s spots, cough and erythema in red patches—what disease does he or she most likely have?
Measles
Which of the following IS NOT recommended as initial therapy for a patient with diabetes and hypertension?
Beta-Blocker
Which of the following is the recommended initial therapy for a patient with hypertension who has had a previous MI?
ACEI
Which of the following are common side effects of beta blockers ?
- fatigue
- bradycardia
- headaches
- impotence
What are the initial lab investigations that should be completed before starting antihypertensive medications?
- serum potassium, sodium and creatinine
- urinalysis
- urinary albumin and/or albumin-creatinine ratio in patients with diabetes
- fasting glucose and/or HbA1c
- total cholesterol, HDL-C, LDL-C, triglycerides (lipids may be measured in the fasting or nonfasting state)
- standard 12-lead ECG
In a patient with high LDL, HDL and TG what treatment option can be considered?
HMG CoA reductase inhibitors
What is a common side effect of HMG CoA reductase inhibitors?
GI upset
What common food product should not be consumed when taking statins?
Grapefruit juice may increase serum concentrations
What foods should be avoided within 2 hrs of taking immediate release niacin?
- Spicy foods
- Reassure patients that symptoms abate with time.
- Also, avoid hot drinks, hot showers, alcohol for 1–2 h after a dose.
- Uncoated ASA 325 mg daily may be helpful in the first few weeks of treatment or when increasing the dose.
- Tolerance develops within several weeks.
- Avoid missing a dose.
What are evidence-based, non-pharmacological interventions for lowering lipids?
- weight loss
- stress management
- increased physical activity
- smoking cessation
What important administration information should be provide to clients when prescribing resins?
Also called Bile Acid Sequestrants
- Administer 1 hour before or 4-6 hours after other medication
- Take with plenty of water to prevent constipation
- May mix with water, juice, soup or applesauce
