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Pharm 103 Exam 1 Flashcards

1
Q

What is the difference between a DVT and a PE?

A

A DVT is a blood clot forming in the veins, a PE is a clot that has moved into the lungs

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2
Q

What situations require heparin for rapid anticoagulation?

A

Afib, PE, DVT, stroke

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3
Q

What foods should be avoided when taking allopurinol?

A

Foods high in purin content (organ meats, salmon, sardines, gravy, legumes)

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4
Q

What is the MOA of heparin?

A

Binds with antithrombin III, accelerating the anticoagulation cascade and inhibiting the action of thrombin, which prevents the conversion of fibrinogen to fibrin and stops a clot from forming

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5
Q

What is the MOA of parenteral anticoagulants?

A

Binds with and inhibits free-flowing thrombin

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6
Q

What is the MOA of oral anticoagulants?

A

Inhibit hepatic synthesis of vitamin K, affecting clotting factors II, VII, IX, and X

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7
Q

What lab tests need monitored when a patient is receiving heparin?

A

PTT and aPTT (can also decrease platelets)

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8
Q

What is the antidote to heparin or LMWH overdose?

A

Protamine sulfate (IV)

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9
Q

How are LMWH different to heparin?

A

LMWHs have a lower risk of bleeding and produce more stable responses at recommended doses, don’t need frequent lab monitoring of aPTT, and have a half life that is 2-4 times longer than that of heparin

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10
Q

Why is oral warfarin started before ending heparin?

A

Prevents other clots from forming (rebound?)

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11
Q

All anticoagulants are contraindicated in which patients?

A

Patients with head trauma, bleeding in the brain, history of brain bleeds, or active bleeding

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12
Q

What medications are discouraged when taking anticoagulants?

A

Antiplatelet drugs (like aspirin)

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13
Q

How do oral anticoagulants, such as warfarin, work to prevent clotting?

A

Inhibit hepatic synthesis of vitamin K, thus affecting clotting factors II, VII, IX, and X

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14
Q

What lab tests is used to monitor anticoagulation with warfarin and when is it drawn?

A

PT and INR; drawn right before next drug dose

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15
Q

How is INR different than a PT?

A

INR accounts for variability in reported PTs from different labs

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16
Q

What is a normal PT and INR?

A

Pt: 11-12.5 seconds
INR- 1.3-2 seconds

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17
Q

What is the ideal INR of a patient on warfarin?

A

2-3

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18
Q

What is the antidote to warfarin overdose?

A

Vitamin K (takes 24-48 hours to be effective)

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19
Q

Why is heparin safer than wafarin in pregnancy?

A

Heparin does not cross the placental barrier, unlike warfarin; warfarin use is not recommended during pregnancy

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20
Q

How do antiplatelets work to prevent thrombosis in the arteries?

A

Antiplatelts suppress platelet aggregation

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21
Q

How soon prior to surgery should aspirin be discontinued?

A

At least 7 days before surgery

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22
Q

How soon should a thrombolytic be administered after an AMI?

A

Within 3-4 hours (ideally within 30 minutes)

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23
Q

Should anticoagulants and antiplatelets he given at the same time at alteplase?

A

No- there is an increased risk for bleeding

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24
Q

What is the antidote for alteplase?

A

Aminocaproic acid

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25
Inherent resistance
Occurs without previous exposure to the drug; occurs naturally
26
Acquired resistance
Caused by prior exposure to the antibacterial
27
Additive effects
Equal to the sum of the effects of two antibiotics
28
Potentiative effects
Occurs when one antibiotic potentiates the effect of the second, increasing its effectiveness
29
Antagonistic effect
When a bactericidal drug and and bacteriostatic drug are used together, which can greatly reduce the desired effect
30
What are the three general adverse effects to antibacterials?
Allergy or hypersensitivity, superinfection, and organ toxicity
31
Which superinfections are common after antibiotic therapy?
MRSA and C. Diff
32
How do penicillins affect oral contraceptives?
Decreases effectiveness of oral contraceptive
33
How do penicillins effect potassium?
Increases serum potassium levels
34
How do penicillins affect aminoglycosides?
Actions of both drugs are inactivated
35
How are cephalosporin generations different?
The higher the generation, the more resistant to beta-lactamases, the larger the spectrum, and the more increased the ability to reach cerebrospinal fluid
36
How can patients prevent superinfection?
Take medication for full course, eat yogurt, buttermilk, or an acidophilus supplement
37
How do penicillins or cephalosporins affect bleeding risk?
Increase risk for bleeding by inhibiting platelet function
38
What route can macrolides not be given in and why?
IM- too painful. Give orally OR IV slowly instead to prevent phlebitis
39
How does C. Diff result from macrolide use?
Extended use of macrolides can kill the normal flora in the gut, allowing an overgrowth of c. Diff
40
Which antibiotic is typically prescribed to treat c-diff?
Fidaxomicin
41
Why should patients report loose stools when on azithromycin?
CDAD needs to be ruled out
42
What are the two types of toxicity caused by vancomycin?
Nephrotoxicity and ototoxicity
43
What infection is vancomycin widely used for?
Staphylococcal infections
44
Is a vancomycin infusion reaction an allergic reaction?
No- it's a toxic effect
45
How can a nurse prevent vancomycin infusion reaction?
Infuse slowly
46
Which drugs increase the risk of ototoxicity and nephrotoxicity when given with vancomycin?
Furosemide, aminoglycosides, ammphotericin B, colistin, cisplatin, and cyclosporine
47
When should tetracyclines be taken in relation to food? Which ones are not included in this?
On an empty stomach 1 hour before or 2 hours after meals; doxycycline and minocycline are outliers to this rule and do better with food, specifically milk
48
What are the most common side effects of tetracyclines?
Nausea, vomiting, diarrhea, and photosensitivity
49
How are digoxin and warfarin affected by concurrent use with tetracyclines?
Increased effects of digoxin and warfarin
50
Which patients are most affected by tooth discoloration from tetracyclines?
Children under 8 and pregnant women in the last trimester
51
How do fluoroquinolones affect oral hypoglycemics and blood glucose?
Increases effects of oral hypoglycemics; increases risk for hypoglycemia
52
What types of infections are sulfonamides primarily used to treat?
UTIs, E.Coli, meningococcal meningitis, chlamydia, toxoplasma gondii, coccal infections
53
Why should the nurse monitor for bruising or bleeding when a patient is taking a sulfonamide?
Blood disorders such as hemolytic anemia, aplastic anemia, and low WBC and platelet counts can result from prolonged use and high dosages
54
When should a patient take a sulfonamide in relation to food?
1 hor before or 2 hours after meals with a full glass of water
55
Why should patients increase fluid intake when taking a sulfonamide?
To prevent crystalluria
56
Why are multi-drug combinations important in HIV treatment?
Taking single ARVs can increase the risk of drug resistance to all ARVs
57
What are the common side effects of NRTIs?
Nausea, diarrhea, abdominal pain, rash
58
What are the common side effects of NNRTIs?
Dizziness, sedation, nightmares, euphoria, loss of concentration, rashes
59
What are the common side effects of PIs?
N/V, diarrhea, rash
60
Which health screenings are important to encourage for a patient with HIV?
Pap tests, ophthalmologic and dental examinations, and agr or risk-related colonoscopies
61
Which laboratory tests are important to monitor while a patient is taking antiretrovirals for HIV?
Viral load and CD4+ counts
62
Describe adjuvant therapy
Cancer that is treated with surgery and ending with chemotherapy
63
Why is chemotherapy usually administered in cycles?
Improves the likelihood thematic cancer cells will be destroyed and normal cells can recover
64
Why is chemotherapy usually administered as combination therapy?
Combination therapy increases the likelihood of affecting cancer cells in all phases of the cell cycle
65
When do patients typically reach nadir?
7-10 days after treatment
66
What would the nurse do if extravasation began in an IV line?
Stop the infusion immediately
67
What are the signs of neurotoxicity specific to a patient taking vincristine?
Sensory loss, paresthesias, difficulty walking, hyporeflexia, and muscle wasting
68
What effect do monoclonal antibodies have on the immune system?
Improves the immune system to find and attack cancer cells
69
Why are diphenhydramine and acetaminophen used as premedications for mAb infusions?
They help to prevent nausea, blood pressure changes, hyperglycemia, and hypoxia
70
How do BRMs enhance the immune system?
-enhance immune systems ability to kill abnormal cells (immunomodulation) -change cancer cells to make them behave more like healthy cells -inhibit normal cells from changing into cancer cells -enhance the body's ability to repair or replace damaged cells caused by other cancer treatments -prevent cancer cells from metastasizing
71
When should a patient stop taking erythropoietin?
When the hemoglobin concentration is higher than 11 g/dL
72
What are the 3 ways antiseizure drugs work?
-suppressing sodium influx through the drug binding to the sodium channel when it is inactivated, which prolongs the channel inactivated and thereby prevents neuron firing -suppressing the calcium influx, which prevents the electric current generated by the calcium ions to the T-type calcium channel -increasing the action of GABA, which inhibits neurotransmitters throughout the brain
73
Why do children need a higher dose of phenytoin?
They have a higher metabolism, which decreases drug availability
74
Which IV solution can phenytoin not mix with?
Dextrose solutions (D5W, D10)
75
Why route should phenytoin not be administered through? Why?
IM- erratic absorption rate and tissue irritation/damage
76
How does phenytoin affect blood glucose?
Increases blood sugar by inhibiting the production of insulin
77
How does phenytoin affect oral health?
May cause gingiva hyperplasia (overgrowth of gums or reddened gums that bleed easily)
78
How does phenytoin interact with aspirin and anticoagulants?
Increases their drug activity and availability
79
Which long-acting barbiturate is prescribed to treat seizures and status elipticus?
Phenobarbital
80
Which benzodiazepine is administered IV for status elipticus? Followed by which drugs?
Diazepam is administered first, followed by phenytoin or phenobarbital (other antiseizure drugs)
81
What patients should not take anticholinergics?
Patients with dementia or memory loss
82
What medications treat drug-induced parkinsonism?
Anticholinergics
83
When is levodopa inhalation used?
As needed in between treatments of carbidopa levodopa
84
What does carbidopa-levidopa do?
Decreases symptoms of PD; the carbidopa allows for less levodopa to be used because it is a decarboxylase inhibitor
85
What happens to urine when on carbidopa-levidopa?
It becomes discolored and can darken when exposed to oxygen- this is normal
86
What foods should be avoided when taking selegiline?
Foods high in tyramine (to avoid hypertensive crisis)

Pharm Exam 2 (3 decks)

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