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ANCC Review > Liek > Flashcards

Liek Flashcards

1
Q

Initial treatment of an uncomplicated case of Helicobacter pylori-negative peptic ulcer disease?

A

H2 receptor antagonists

Z-P

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2
Q

Has the shortest half-life of about 2 hours

A

Triazolam (Halcion)

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3
Q

Has a half-life of 12 hours

A

Alprazolam (Xanax)

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4
Q

Has a half-life of 15 hours

A

Lorazepam (Ativan)

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5
Q

Has a half-life of 34 hours

A

Clonazepam (Klonopin)

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6
Q
  • Sulfonylureas class are typically well tolerated

- Levofloxacin (Levaquin)

A

Sulfa allergy

Bactrim

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7
Q

Medications is indicated for the treatment of obsessive-compulsive disorder?

A

Paroxetine (Paxil CR)

SSRI

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8
Q

Haloperidol (Haldol)

A

Antipsychotic

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9
Q

Alprazolam (Xanax)

A

Benzodiazepine

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10
Q

Amitriptyline

A

Tricyclic antidepressant

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11
Q

First-line treatment for osteoporosis

A

Bisphosphonates

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12
Q
  • (DEXA) scores are reported as either T-scores or Z-scores, but T-scores are more commonly used.
  • A T-score between -1 and -2.5 indicates osteopenia.
  • T-score of -1 or higher is normal
A

Dual-energy x-ray absorptiometry (DEXA)

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13
Q

Ciprofloxacin is the preferred drug and other option is levofloxacin (Levaquin).

A

Anthrax (Bacillus anthracis) prophylaxis

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14
Q
  • motion/sea sickness.
  • small, circular patch that is placed behind the ear and is effective for 3 days.
  • apply it 4 hours before the trip to be effective.
A

Scopolamine patch (Transderm Scop)

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15
Q

Determines how much of the active drug is available to the body (bioavailability). Depending on the drug and other factors, a drug may be poorly metabolized or extensively metabolized by the liver.

A

First-pass metabolism (first-pass effect)

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16
Q

Can adversely affect the retina (scotomas or visual field defects, loss of central vision, loss of color vision). Higher doses and long-term use increase the risk of retinal toxicity.

A

Hydroxychloroquine (Plaquenil)

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17
Q

Penicillin (Pen VK) is safe to use for strep throat

A

During pregnancy

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18
Q

Clarithromycin (Biaxin) BID, amoxicillin BID, and omeprazole (Prilosec) daily

A

“Triple therapy” for treating a Helicobacter pylori infection?

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19
Q
  • Mimic the action of estrogen in the body. They are derived from soybeans and soybean products (soy milk, tofu). - Supplementation with isoflavones may help some women with menopausal hot flashes.
A

Soy isoflavones (phytoestrogens)

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20
Q
  • Best option is to use azithromycin

- Patient is a child, the levofloxacin is contraindicated.

A

Severe penicillin allergy

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21
Q

Topical Nasal Decongestants:

Oxymetazoline Nasal Spray (Afrin)

Phenylephrine (Neo-Synephrine)

A

Short-term use of topical nasal decongestants (twice a day as needed × 3 days) is considered safe treatment for nasal congestion (common cold, allergic rhinitis).

Rhinitis medicamentosa is due to chronic use (>3 days) of nasal decongestants.

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22
Q

Antihistamines (Histamine Antagonist or H1 Blocker):

Diphenhydramine (Benadryl)
Loratadine (Claritin)
Cetirizine (Zyrtec)

A

Avoid using diphenhydramine (Benadryl) in the elderly.

For elderly patients, use loratadine (Claritin) because it has a lower incidence of sedation.

Zyrtec is more potent and long acting. It is very effective for acute and chronic urticaria.

Topical Antihistamines;

Nasal sprays: Allergic rhinitis, seasonal allergic rhinitis, vasomotor rhinitis
Azelastine (Astelin) nasal spray

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23
Q

Ophthalmic Drops

A

Pruritus from allergic conjunctivitis
Azelastine hydrochloride ophthalmic solution 0.5%

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24
Q

Decongestants

Pseudoephedrine (Sudafed)

phenylephrine

A

The Combat Methamphetamine Epidemic Act of 2005 restricts the amount of pseudoephedrine you can buy.

Decongestants (stimulants) are contraindicated with hypertension and coronary artery disease (CAD; angina, MI).

Advise patients that mixing decongestants with other stimulants (caffeine, Ritalin, albuterol inhaler) will cause heart palpitations, tremors, and anxiety.

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25
Q

Antitussives;

Dextromethorphan (Robitussin, Delsym)

benzonatate (Tessalon)

A

Dextromethorphan increases risk of serotonin syndrome (major drug interaction) with monoamine oxidase inhibitors (MAOIs), selegiline (Eldepryl), SSRIs, and SNRIs

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26
Q

Mucolytics

A

Guaifenesin and water (hydration)

27
Q

Topical Nonsteroidal Anti-Inflammatory Drugs

A

Diclofenac gel 1% (Voltaren Gel), diclofenac solution 1.5% (Pennsaid), patch 1.3% (Flector)
Skin topical: Joint pain (knees, hands) from osteoarthritis/degenerative joint disease (DJD)

28
Q

Ophthalmic Nonsteroidal Anti-Inflammatory Drugs

A

Seasonal allergic conjunctivitis (for itch), eye pain after cataract surgery
Ketorolac ophthalmic (Acular), diclofenac sodium (Voltaren ophthalmic)

29
Q

NSAIDs should be avoided in

A

*HF
*severe heart disease
*GI bleeding
*severe renal disease
*during the last 3 months of pregnancy (blocks prostaglandins).

*Patients with nasal polyps and asthma can be sensitive to aspirin/NSAIDs.

30
Q

Ketorolac (Toradol) is for_______ use only

Should not be used____

A

short-term use only- Maximum number of days that ketorolac (Toradol) can be used is 5 days. First dose given intramuscular or IV, then continue

should not be used before surgery, with concurrent acety lsalicylic acid (ASA), pediatric patients, active or recent GI bleed, stroke, labor/delivery, and others.

31
Q

For long-term use of NSAIDs, document

and consider prescribing____

Avoid long term use if

A

DOCUMENT informed consent such as the higher risk of serious MI, stroke, emboli, GI bleeds, and acute renal failure.

For long-term use, consider prescribing concurrent proton-pump inhibitors (PPIs), H2 antagonists, or misoprostol (Cytotec). Cytotec is a synthetic prostaglandin.

Avoid long-term use of NSAIDs if patient is on aspirin prophylaxis (interferes with aspirin’s cardioprotective effect).

32
Q

COX-2 inhibitors (celecoxib) have lower risk of _________.

They are not a first-line NSAID, except for patients ________.

A

GI bleeding compared with the other NSAIDs

at high risk for GI bleeding.

33
Q

NSAIDs may worsen

A

hypertension in patients who were previously well controlled.

34
Q

Salicylates:

Aspirin (Bayer)

A

*Aspirin irreversibly suppresses platelet function for up to 4 days (because of irreversible acetylation). Life span of platelets is about 10 days.

*Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity)

Topical: Methyl salicylate and menthol (BENGAY gel/cream)

Nonacetylated salicylates: Salsalate (Disalcid), namebutone (Relafen)

Thromboembolic stroke: Take immediate-release aspirin

Do not take aspirin under the age of 12 years (Reye’s syndrome)

35
Q

Capsaicin

Capsaicin topical cream (Zostrix HP)

A

NSAID

Capsaicin cream can be used to treat pain in trigeminal neuralgia and PHN.

May take up to 4 weeks to work; may cause temporary burning sensation; do not use on broken skin; advise patient to wash hands with soap and water immediately after using capsaicin cream and to avoid touching the eyes, nose, and mouth.

36
Q

Acetaminophen (Tylenol)

A

*Adults and children ≥12 years of age
*Considered first-line drug for pain from osteoarthritis/DJD
*The maximum dose for acetaminophen (Tylenol) ranges from 3 to 4 g/d.
*Duration: Do not use for more than 10 days unless directed by health provider.
*Avoid if: Chronic hepatitis B/C/D, dehydration, liver disease, cirrhosis, heavy drinker

*Antidote for overdose: Acetylcysteine (Mucomyst)

*Risk of severe liver damage if intake of three or more alcoholic drinks per day while using medication

37
Q

Oral corticosteroids are first-line treatment of__________

Oral or systemic corticosteroids are adjunct treatment for ________

Inhaled corticosteroids are first-line treatment for __________

A

polymyalgia rheumatica (dramatic relief of symptoms) and temporal arteritis/giant cell arteritis

rheumatoid arthritis, lupus, other autoimmune disorders, anaphylaxis, and septic shock.

asthma; short-term burst of oral steroids are used to treat exacerbations.

38
Q

Topical Steroids

A

*Classification: Group 1 (superpotent) to Group 7 (least potent)
*Topical steroids are first-line or adjunct treatment for some inflammatory skin diseases or acute cases of dermatitis such as contact dermatitis.

*Use low-potency steroids for the face, intertriginous areas, and genitals (thinner skin).
Example: Use hydrocortisone cream/ointment/lotions 0.5% to 1% (OTC) to prescription strength such as hydrocortisone 2.5% (Hytone Rx).

*Avoid topical steroids around the eye area and/or eyelids. They can leach into the eye and cause secondary glaucoma (and blindness) in susceptible individuals. Refer to dermatalogist.

*Use moderate- to high-potency steroids for thicker skin (scalp, soles of feet, palms of the hands) or for plaques (psoriasis).

*Taper potent-strength topical steroids (or will rebound).
If higher potency steroids are necessary, refer to dermatologist, since at high risk of suppression of the hypothalamic–pituitary–adrenal (HPA) axis.

*Infants and young children have thinner stratum corneum than adults, so they absorb topical steroids very well, which increases risk of adverse effects.

39
Q

Topical steroids:

What is occlusion?

A

Thick resistant psoriatic plaques are sometimes treated by using occlusion (increases absorption 10-fold).

The topical steroid is applied to the plaque and is covered with dressing or plastic wrap.

Ultrapotent steroids (Temovate, etc.) should not be occluded for more than 2 weeks (risk of HPA suppression).

40
Q

Side Effects of Glucocorticoids/Steroids (Chronic Use)

A

*HPA axis suppression
*Secondary Cushing’s disease (e.g., dorsal hump, rounded face)
*Osteoporosis (advise weight-bearing exercises, vitamin D, calcium 1,200 mg/d, bisphosphonates)
*Immunosuppression (increased risk of infection)

*Skin changes from long-term topical therapy (skin atrophy, striae, telangiectasia, acne, pigmentation changes)

41
Q

A severe case of poison ivy or poison oak rash may require _______ days of an oral steroid to clear.

A

14 to 21 days

42
Q

Theophylline (bronchodilator) Drug Interactions

A

*Drug interactions: Cimetidine, alprazolam, macrolides, fluvoxamine, others;
*avoid combining with other stimulants (theophylline, pseudoephedrine, caffeine, Ritalin)
*Disorders worsened by stimulants: Hypertension, arrhythmias, heart disease, stroke, seizures
*BPH: Causes urinary retention, worsening of symptoms (due to spasm of sphincters)
*Suspect toxicity if persistent vomiting

43
Q

Drugs to Avoid During Pregnancy

A

*Finasteride (Proscar, Propecia): Reproductive-aged or pregnant women should not handle crushed/broken finasteride tablets
*Isotretinoin (Accutane)
Warfarin sodium (Coumadin)
*Misoprostol (Cytotec)
*Androgenic hormones: Birth control pills, hormone replacement therapy (HRT), testosterone
*Live virus vaccines (measles, mumps, rubella, varicella, rotavirus, FluMist)

*Thalidomide (skin conditions-leprocy)
*diethylstilbestrol (DES)-AKA estrogen
*methimazole (used to treat hyperthyroidism)

44
Q

Schedule II drugs (e.g., Demerol, Dilaudid, OxyContin, cocaine, amphetamines, fentanyl)

A

*have zero refills, and maximum quantity dispensed is for 30 days only.

*It cannot be called in by phone. It has to be written on a traditional paper prescription pad (some states now accept electronic prescriptions).

*Prescription will automatically expire in 6 months

45
Q

Maximum number of refills for Schedule III to V drugs

A

is five refills (limit of 90 pills per refill).

46
Q

Conventional medicine (or allopathic medicine) is also known as

A

modern medicine or Western medicine.

47
Q

Herbals are also called

A

botanical medicine or phytomedicine

48
Q

Complementary and alternative medicine (CAM) is the term for medical practices and products that are

A

not part of standard medical care.

Examples include herbal supplements, probiotics, chiropractic, homeopathy, meditation, yoga, massage therapy, essential oils, tai chi, cupping, coining, sound/light therapy, acupuncture, acupressure.

49
Q

Integrative medicine

A

is a total approach to medical care (mind, body, and spirit) that combines standard medicine with CAM practices that have been shown to be safe and effective.

50
Q

Echinachea (purple coneflower):

A

Used to shorten duration of common cold or flu; avoid if history of autoimmune disease or allergic to ragweed (may cause anaphylaxis)

51
Q

Feverfew or butterbur:

A

Migraine headache

52
Q

Cinnamon:

A

Improves blood sugar (diabetes) and cholesterol

53
Q

Glucosamine (with/without chondroitin):

A

Osteoarthritis

54
Q

Ginkgo biloba:

A

Dementia, memory problems, tinnitus;
*affects blood-clotting; stop taking 2 weeks before surgery (including dental procedures);
*NSAIDs will increase risk of bleeding.

55
Q

Natural progesterone cream or sublingual capsules (from Mexican wild yam or soybeans):

A

Premenstrual symptoms and menopausal symptoms such as hot flashes; no research on safety with long-term use

56
Q

Isoflavones (from soybeans):

A

Estrogen-like effects

57
Q

Saw palmetto:

A

Urinary symptoms of BPH

58
Q

Kava kava, valerian root:

A

Anxiety and insomnia; do not mix kava kava with CNS drugs, since it will worsen the sedative effect

59
Q

St. John’s wort:

A

Mild depression; do not use with SSRIs, sumatriptan, HIV protease inhibitors (indinavir), others.

60
Q

Turmeric:

A

Alzheimer’s disease, arthritis, cancer

61
Q

Fish or krill oil, omega-3 oil:

A

Heart disease, high cholesterol, arthritis/joint pain (reduces inflammation)

62
Q

What is the Homeopathic Pharmacopoeia of the United States?

A

It is a list of approved homeopathic substances used in this country.

63
Q

How are homeopathic substances made?

A

Extremely small amounts of a substance are diluted (ultradilution). For example, the herb Arnica montana, which is used to treat pain and muscle aches and prevent or treat bruises, can be diluted 30 times (e.g., A. montana 30× dilution)

64
Q

Ayurveda

A

An ancient healing system from India. Food, spices, herbs, yoga, and lifestyle are believed to prevent and treat disease. For example, turmeric powder is also used to treat cuts and abrasions

ANCC Review (19 decks)

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