Pharm Flashcards
patients with sulfa allergies should aaoid what bp meds
thiazide and loops
what alternative potassium sparing diuretic should be used in pts who have a sulfa allergy
triaterine and amiloride (midamor)
side effect of spironolactone is
gynecomastia and hyperkalemia
A fairly common (5%–20%) side effect of ACEIs
dry cough. The cough may occur a few hours after the first dose or within weeks to months. Stop the ACEI and switch to another antihypertensive drug class or switch to an ARB (diabetic, CKD, HF).
ACEIs and ARBs are contraindicated in
pregnancy, renal artery stenosis, angioedema, hyperkalemia (>5.5 mmol/L), and hypersensitivity to the drug.
ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of
treatment of hypertension in diabetics and patients with mild-to-moderate CKD. But if severe CKD (eGFR <60), avoid these drugs because of higher risk of hyperkalemia.
Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients with
HFrEF (can worsen it).
CCB can cause what
Peripheral edema
Hypotension and bradycardia are the main symptoms of
CCB poisioning
Alpha-blockers are potent vasodilators. Common side effects are
dizziness and hypotension. Give at bedtime at very low dose and slowly titrate up. Careful with frail elderly (risk of syncope and falls).
Tetracyclines can decrease what
oral contraceptives
erythromycin has many
GI side effects
what is the most well tolerated macrolide with rare GI effects
azithromyocin
May prolong INR and increase risk of bleeding if warfarin is mixed with e
erythromycin or clarithromycin.
pts who have a true allergy to PCN are more likely to have an allergy to
cephalosporings
Dicloxacillin is for
(mastitis and impetigo).
Some women will experience candida vaginitis with
Recommend taking probiotic capsules or eating yogurt daily. If needed, suggest use of OTC miconazole.
Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with
ciprofloxacin 500 mg every 12 hours × 60 days (treat within 48 hours). In addition, a three-dose series of anthrax vaccine is recommended.
Cutaneous anthrax is treated with
ciprofloxacin 500 mg twice a day × 7 to 10 days.
Traveler’s diarrhea (severe) is treated with
Cipro 750 mg (single dose) or 500 mg twice a day × 3 days.
Ciprofloxacin has the best activity against Pseudomonas aeruginosa (gram negative) and is the first-line drug for treating
pseudomonal pneumonia for patients with cystic fibrosis.
For athletes or very physically active patients, if fluoroquinolone is needed, advise to
reduce their training volume and intensity to reduce risk of Achilles tendon injury. Wait from 2 to 4 weeks after completion of fluoroquinolones before resumption of sport or activity.
Patients with a UTI who are on warfarin (Coumadin) should not be given
MP-SMX (increased risk of bleeding). Monitor INR closely.
clindomyocin put you at high risk for
C diff
Decongestants (stimulants) are contraindicated with
hypertension and coronary artery disease (CAD; angina, MI).
Maximum amount of time that ketorolac (Toradol) can be used
5 dayss
Discontinue ASA if patient complains of
Tinnitus
Capsaicin cream can be used to treat pain in
Trigeminal neuralgia and PHN
The maximum dose for acetaminophen (Tylenol) ranges from
3 - 4
A severe case of poison ivy or poison oak rash may require
14 to 21 days of an oral steroid to clear.
The most common cause of acute liver failure in the United States is
acetaminophen overdose.
schedule of drugs
1 is
2 is
3 is
IV
V
1 heroin, ecstasy, PCP
2 demerol , icy, cocaint
3 tylenol with Codeine, Vicodin
4 cough meds, lryica
Maximum number of refills for Schedule III to V drugs is
five refills (limit of 90 pills per refill).
Schedule II drugs have how many refills
o refills
Echinachea
common cold
feverfew or butterbur
migraine
Ginko is for
dementia, memory
isoflavones for
estrogen
Turmeric
alzheimers arthritis
fish oil
heart
kava kava and valareian root
anxiety
xMacrolides:
erythromycin, azithromycin, clarithromycin.
Quinolones:
ciprofloxacin (Cipro), ofloxacin (Floxin)
Sulfa:
Trimethoprim-sulfamethoxazole (Bactrim).
what do you treat lung infections with comorbidites with
fluroquionoles
Tetracyclines:
tetracyclien and doxy
Lung infections with no comorbidites
macrolide
If antibiotics in the past 3 months
Doxy
* Levofloxacin
* Azithromycin or Clarithromycin + Amoxicillin or Augmentin
treat pertussis with what
marcolide
azithromyocin
erythromycin
clarithromyocin
Treat strep with what
PCN, amoxicillin
acute rhinosinusitis should do what before treatment
wait ten days then amoxicillin
Pancreas makes
insulin and glucagon
Rapid acting covers
Lispro, aspart or gluisine
one meal at a time
short acting is Regular
meal to meal
intermidiate is (NPH)
breakfast to dinner
long acing is (Glargine)
all day
Aces end in
Prils
lisinopril, enalapril
Arbs end in
sartan - losartan, valsartan
Ace and arbs cause
dry cough
Beta Blockers
Metoprolol, atenolol, propranolol.
Beta blockers are contraindicated in what pts
asthma, COPD, ephysema
Propranolol is also used for
Fine tremors
calcium channel blockers send in
pine
CCB side effects are
HA and ankle edema and contraindicated in CHF
CCB are
Nifedipine, amlodipine, verapamil, diltiazem.
CCB are also treatment for what disease
raynauds
Thiazides side effects
Hyperglycemia
* Hyperuricemia (don’t use in gout)
* High triglycerides
* High cholesterol
Thiazides can be used for
osteopenia and osteoprosis in pts with HTN
Preferred 1st line drug to tx HTN in DM and pts. with mild to moderate renal disease:
ACe and arbs
Beta blocers common side effect is
fatigue and depression
Alpha-1 blockers/antagonists
Zosin
terazosin, doxazosin,
tamsulosin for BPH
Take at bed
animal bites treat with
augmentin
Anticoagulation therapy (warfarin or coumadin)
* Avoid excess intake of
itamin K rich foods: dark green leafy vegetables, broccoli,
Spironolactone induces g
gynecomastia
1ST line tx strep throat:
penicillin. If allergic, Macrolide.
Only two methods of contraception that do not contain hormones are
condoms and copper T.
Bisphosphonates: warning
with erosive esophagitis, abdominal pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.
Statins (Lipitor, Crestor) don’t ever mix with
Grapefruit juice
Trichomonas tx:
Trichomonas tx:
BV treat with
Trichomonas tx:
Gonorrhea tx:
Ceftriaxone 500mg IM x 1.
Syphilis tx
Penicillin.
Atrophic vaginitis tx
topical estrogen
Condyloma Acuminata tx:
(genital warts, HPV) Condylox, Imiquimod.
Chlamydia tx:
Doxy or Azithromycin *tx partner too
H. Pylori tx:
Triple: PPI or ranitidine bismuth citrate, combined with Clarithromycin and Amoxicillin or Metronidazole.
* Quadruple: Bismuth+ Flagyl+ tetracycline+ PPI
* * bismuth can turn stool dark*
Atypical antipsychotics
Weight gain, metabolic syndrome, DM II. Monitor weight every 3 months.
Meds safe in pregnancy:
PCN, metformin, cephalosporins, Tylenol, prednisone, insulin.
Every pregnancy gets a Tdap
3rd trimester (27-36 wks.).
Flu vaccine is it ok in pregnancy
yes
otitis media treatment is
amoxicillin
cutaneous anthrax is
cirpo 500 mg twice a day for 60 days
erysipelasa
PCN or macrolide
Purulent cellulitis
MRSA
* Incision and drainage
* Bactrim, Clindamycin, Doxy (B,C,D)
* Non-purulent cellulitis * Gram+
* cephalexin (Keflex)
first line tx for MRSA is
Bactrim unless allergic treat with clindamycin
what are antifunglas
azoles and allylamines
do not use sulfonamides in what trimester of preganancy
3rd causes risk for hyperbilrubinemia
The ACC/AHA stages of hypertension are as follows:
Normal blood pressure is systolic <120 mmHg and diastolic <80 mmHg; elevated blood pressure is systolic 120 to 129 mmHg and diastolic <80 mmHg; stage 1 hypertension is systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg; and stage 2 hypertension is systolic >140 mmHg or diastolic >90 mmHg.
Which of the following medications is appropriate to prescribe for treatment of fibromyalgia?
A.Celecoxib (Celebrex)
B.Diclofenac (Voltaren)
C.Oxycodone (OxyContin)
D.Nortriptyline (Pamelor)
Answer: D. Nortriptyline (Pamelor)
Fibromyalgia is frequently treated with antidepressants, often tricyclic antidepressants (TCAs) such as nortriptyline. This TCA is effective in treating the pain and sleep disturbances associated with the disorder. Celecoxib and diclofenac are prescription non-steroidal anti-inflammatory drugs (NSAIDs), a medication class that is not typically effective in treating fibromyalgia pain. There is no strong evidence that opioids are more effective in treating fibromyalgia pain than antidepressants, so the risks of prescribing oxycodone likely outweigh the benefits.
Which of the following best describes minimum inhibitory concentration?
A.Lowest concentration of an antibiotic necessary to inhibit bacterial growth
B.Lowest concentration of a medication needed to achieve a response
C.Lowest concentration of a medication necessary to inhibit undesirable side effects
D.Lowest concentration of a medication needed to inhibit first-pass metabolism
Lowest concentration of an antibiotic necessary to inhibit bacterial growth
The minimum inhibitory concentration is the lowest concentration of an antibiotic needed to inhibit bacterial growth after overnight incubation. Although the lowest concentration of a medication needed to achieve a response is a goal when prescribing medications, it is not the definition of minimum inhibitory concentration. It is also not defined by the lowest concentration needed to inhibit undesirable effects or the first-pass metabolism.
The nurse practitioner is reviewing the medications of a 72-year-old patient who states, “Ever since I started these medications, my skin constantly feels itchy.” Which prescription will the nurse practitioner associate with the patient’s condition?
A.Olmesartan (Benicar) 10 mg PO daily
B.Venlafaxine (Effexor) 75 mg PO daily
C.Metformin (Glucophage) 500 mg PO BID
D.Hydrochlorothiazide (Microzide) 25 mg PO dail
Hydrochlorothiazide (Microzide) 25 mg PO daily.
Hydrochlorothiazide is a drug commonly associated with systemic pruritis in the older adult. Olmesartan, venlafaxine, and metformin are not commonly associated with systemic pruritis in the older adult.
The nurse practitioner is educating a group of patients on the possible side effects of chronic medical cannabis use, which includes:
A.Neuropathies
B.Low sperm count
C.Tardive dyskinesia
low sperm count
A patient prescribed azithromycin is concerned about taking the medication due to a history of vomiting and diarrhea after taking erythromycin. The appropriate response by the nurse practitioner is:
A.”I will prescribe an antiemetic if you experience severe vomiting.”
B.”Azithromycin is prescribed for only 5 days, so the side effects should be tolerable.”
C.”The same side effects may not occur with azithromycin.”
D.”The medications are not in the same drug class.
The same side effects may not occur with azithromycin.”
While erythromycin and azithromycin are in the same drug class (macrolides), side effect intolerance for one medication does not automatically apply to all medications in that group. In addition, azithromycin is the most well-tolerated macrolide. If severe vomiting occurs, the medication should be changed. The patient should not be asked to tolerate side effects for 5 days.
Cerebrospinal fluid that is clear, with normal pressure, lymphocytic predominance, elevated protein, and a normal cerebrospinal glucose level and plasma glucose ratio is associated with
viral meningitis
bacterial meningitis is treted with
ceftriaxone and vanco
Treatment of viral meningitis is
tylenol and ibuprofen
amphotercin B is used for what type of meningitis
fungal
A 58-year-old male patient with a history of hypertension, type 2 diabetes, and mild chronic obstructive pulmonary disease (COPD) presents with a 4-day history of dysuria and flank pain. Urinalysis reveals pyuria and bacteria. The patient states that he has not taken any antibiotics in the last year and currently takes metformin for diabetes, amlodipine for hypertension, and a bronchodilator for his COPD. He also mentions that he has recently started taking a new over-the-counter supplement for joint pain. Which of the following quinolone antibiotics is most appropriate to prescribe for this patient’s urinary tract infection (UTI)?
A.Ciprofloxacin
B.Norfloxacin
C.Levofloxacin
D.Moxifloxacin
Answer: B. Norfloxacin
Norfloxacin is primarily excreted in the urine and is commonly used for UTIs.
A parent of a 6-year-old child with allergy-induced asthma tells the nurse practitioner that they would like to have theophylline prescribed to their child because it worked for them when they were young. Which information will the nurse practitioner include in discussion with the parent?
A.”The drug cannot be prescribed until age 12.”
B.”Inhalers cannot be used while on the drug.”
C.”The drug is not a primary treatment for the diagnosis.”
D.”Accurate drug levels are difficult to obtain and monitor.”
Solution: C
“The drug is not a primary treatment for the diagnosis.”
Which medication can cause amenorrhea?
A.Sertraline (Zoloft)
B.Albuterol (Proair) inhaler
C.Omeprazole (Prilosec)
D.Tretinoin (Retin-A) topical
Solution: A
Sertraline (Zoloft).
Medications that increase prolactin production (hyperprolactinemia) can cause secondary amenorrhea. Antipsychotics and selective serotonin reuptake inhibitors (SSRIs; e.g., sertraline) are drug classes associated with this condition. Albuterol and omeprazole do not increase prolactin levels. Tretinoin should be stopped during pregnancy but does not affect menstrual cycles.
sumatriptan increases what in pts
BP
Disulfiram (antibuse) side effects are
metallic taste, skin rash, impotence
A patient with a history of chronic pain and gastroesophageal reflux disease presents for a medication management visit. Current medications are pantoprazole (Protonix) and oxycodone (Xtampza ER). The patient reports they are doing well with no side effects and that symptoms are controlled. Based on this information, the nurse practitioner will:
A.Prescribe naloxone (Narcan)
B.Increase pantoprazole (Protonix) dosage
C.Decrease oxycodone (Xtampza) dosage
D.Discuss limiting acetaminophen (Tylenol) intake
Prescribe naloxone (Narcan).
All patients who are prescribed an opioid should also be prescribed naloxone, the reversal agent for opioids, to be used in the event of an accidental overdose. If symptoms are well controlled and no side effects are present, the dosages of pantoprazole and oxycodone should not be altered. Short-acting oxycodone products, such as Percocet (oxycodone/acetaminophen), contain acetaminophen in each tablet. The maximum daily allowance of acetaminophen should be discussed when prescribed.
mild cellulitis without abscess formation can be treated with
cephalosporin
Which of the following should be monitored in a patient taking chlorpromazine (Thorazine) for the treatment of schizophrenia?
A.Complete blood count
B.Sedimentation rate
C.Liver enzymes
D.Serum potassium
Complete blood count.
Chlorpromazine is a typical antipsychotic used to treat schizophrenia. Patients who are treated with chlorpromazine should be monitored for possible hematologic side effects, such as leukopenia, neutropenia, and various anemia types. A complete blood count would be the most appropriate screening lab test. Sedimentation rate, liver enzymes, and potassium level do not require ongoing monitoring for a patient prescribed chlorpromazine.
first line treatment for BPH is
tamsulosin and terazosin
Finasteride is a
shrinks the prostate
most effective pharmalogical treatment for smoking cessation is
varenicline
When treating a urinary tract infection in a patient who is 38 weeks’ pregnant, the most appropriate antibiotic choice is:
A.Cephalexin (Keflex)
B.Nitrofurantoin (Macrobid)
C.Clarithromycin (Biaxin)
D.Trimethoprim–sulfamethoxazole (Bactrim)
Solution: A
Cephalexin (Keflex).
Cephalexin is considered safe during pregnancy and while breastfeeding, making it the most appropriate UTI treatment for this patient. Nitrofurantoin and sulfa drugs should be avoided in the third trimester due to the risk of hemolytic anemia in the fetus or infant. Clarithromycin is the only medication in the macrolide drug group that is a pregnancy category C.
common side effect of Beta blockers are
cold hands, fatigue, weight gain, depreion, SOB, sexual dysfunction
patient who is has Mysthenia Gravis can not take what antibiotics
macrolides - erythromycin
Beta blocker side effect is
fatigue
The nurse practitioner is reviewing the medications of a 72-year-old patient who states, “Ever since I started these medications, my skin constantly feels itchy.” Which prescription will the nurse practitioner associate with the patient’s condition?
A.Olmesartan (Benicar) 10 mg PO daily
B.Venlafaxine (Effexor) 75 mg PO daily
C.Metformin (Glucophage) 500 mg PO BID
D.Hydrochlorothiazide (Microzide) 25 mg PO daily
Solution: D
Hydrochlorothiazide (Microzide) 25 mg PO daily.
Hydrochlorothiazide is a drug commonly associated with systemic pruritis in the older adult. Olmesartan, venlafaxine, and metformin are not commonly associated with systemic pruritis in the older adult.
