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Pharm -Other Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Several factors influence PA or APRN prescribing authority. Prescribing authority is:

  • Determined by state law
  • The same for PAs and APRNs
  • Is the same in all states
  • Regulated by the federal government
A

-Determined by state law

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2
Q

While rational drug selection is based on the individual patient the aspect of rational drug selection addressing disease-specific information by a national medical or nursing organization is:

  • A guideline
  • Cost
  • Availability
  • Patient hepatic and renal function
A

-A guideline

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3
Q

One aspect of promotion of positive outcomes is medication education. Identify the incorrect statement.

  • Teach the patient purpose of the drug
  • Teach the patient brand or generic name
  • Teach the patient the dosing schedule
  • Teach the patient about adverse reactions
A

-Teach the patient brand or generic name

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4
Q

For Mary, an 89-year-old, Asian female who weighs 110 pounds and is 65 inches tall, several key points must be considered when prescribing.

Identify the most concerning points for Mary’s drug metabolism.

a. Potential for impaired renal and hepatic function due to age, body weight and composition, and female.
b. Body weight and composition, race, potential for tolerance.
c. First pass effect, body weight and composition, and race.
d. Female, body weight and composition, decreased therapeutic action

A

My guess is A?

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5
Q

For Mary, an 89-year-old, Asian female who weighs 110 pounds and is 65 inches tall, several key points must be considered when prescribing.
To reduce the risk of adverse drug reactions for Mary, the prescriber should

a. avoid medications with a boxed warning.
b. evaluate the risk versus benefit of specific medications with monitoring of complete blood count and complete metabolic panel for every visit.
c. provide patient education regarding potential adverse drug reactions with instructions for follow-up.
d. trust that Mary knows her own body and will know if anything changes.

A

??C

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6
Q

Which statement about race as a factor for medication prescribing is most accurate?

a. Race has not been helpful in determining individual drug responses.
b. Individual drug responses based on race are well defined.
c. Specific genetic testing based on a risk factor or specific genetic variation is not helpful in prescribing.
d. Genetic testing across ethnic groups has defined treatment for a variety of disease processes.

A
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7
Q

Pharmacogenomics (Select all that apply.)

a. has limited usefulness in prescribing to individuals.
b. can offer the prescriber insight into expected responses to specific medications.
c. does not identify paths of altered metabolism.
d. provides exact recommendations for drug therapy for prescribers.

A
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8
Q

Britney, a 22-year-old African-American female, is 16 weeks pregnant. She has a preexisting diagnosis of asthma. The advanced practice prescriber knows that

a. her pregnancy has no effect on her asthma.
b. her asthma increases her risk for fetal death.
c. her asthma medications must be discontinued due to risk to the fetus.
d. her asthma medications may be less effective due to pregnancy.

A
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9
Q

Britney, a 22-year-old African-American female, is 16 weeks pregnant. She has a preexisting diagnosis of asthma
When prescribing for Britney, the advanced practice prescriber should consider

a. that any medication Britney receives will cross the placental barrier to the fetus.
b. that medications will be stopped by the placental barrier preventing transmission to the fetus.
c. lipid soluble medications have limited transmission across the placental barrier.
d. protein-bound medications are readily transmitted across the placental barrier.

A
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10
Q

Anisha is a 6-month-old infant. She was full term at delivery with no postdelivery complications. If considering prescribing for her, the prescriber knows

a. drug sensitivity in the infant is related to immature organ systems.
b. renal and hepatic systems are fully developed in utero.
c. prescriptions are based solely on age.
d. gastric emptying is similar to adults at birth.

A
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11
Q

Promoting adherence to medications can be achieved by

a. providing verbal instructions only.
b. selected medications that must be delivered several times a day.
c. trusting the pharmacist will provide flavorings and medication education.
d. medication education regarding dosage, quantity, timing, and duration of treatment.

A
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12
Q

Which medication used in managing alcohol use disorder inhibits acetaldehyde dehydrogenase?

  • Buspirone
  • Sodium Bicarbonate
  • Disulfiram
  • Venlafaxine
  • Escitalopram
  • Flumazenil
A

-Disulfiram

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13
Q

Which medication used in managing alcohol use disorder is an opioid receptor antagonist?

  • Naltrexone
  • Venlafaxine
  • Flumazenil
  • Sodium Bicarbonate
  • Disulfiram
  • Buspirone
A

-Naltrexone (ReVia)- indicated for alcohol & opioid dependence

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14
Q

What is most likely a sign of severe alcohol withdrawal?

  • Ptosis
  • Black vomitus
  • Cough
  • Dermatitis
  • Fever
  • Koplik Spots
A

-Fever

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15
Q

When treating a patient for alcohol use disorder, which of the following considerations is most important?

  • Avoid grapefruit juice
  • Suicide precautions
  • Avoid antacids
  • Avoid potassium supplements
  • Avoid strenuous exercise
  • No calcium intake
A

-Suicide precautions

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16
Q

When treating a patient for alcohol use disorder, which of the following considerations is most important?

  • Avoid diuretics
  • Avoid strenuous exercise
  • Avoid grapefruit juice
  • Avoid antacids
  • Seizure precautions
  • Avoid potassium supplements
A

-Seizure precautions

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17
Q

Which of the following describes the timing of delirium tremens in alcohol withdrawal?

  • 6 hours after last drink
  • 12 hours after last drink
  • 1 day after last drink
  • 2-4 days after last drink
  • 4-6 days after last drink
A

-2-4 days after last drink

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18
Q

Which of the following can be a manifestation of delirium tremens?

  • Hallucinations
  • Osteonecrosis of the jaw
  • Coronary vasospasm
  • Epistaxis
  • Flu-like symptoms
  • Blindness
A

-Hallucinations

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19
Q

Which of the following can be a manifestation of delirium tremens?

  • Koplik spots
  • Sexual dysfunction
  • Inappropriate laughter
  • Bradycardia
  • Migraine
  • Insomnia
A

-Insomnia

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20
Q

Which of the following is a manifestation of delirium tremens?

  • Rash
  • Paralysis
  • Altered mental status
  • Itching
  • Severe headache
  • Pill-rolling
A

-Altered mental status

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21
Q

Which of the following can be a manifestation of delirium tremens?

  • Itching
  • Autonomic Instability
  • Dysuria
  • Miosis
  • Rash
  • Anhidrosis
A

-Autonomic Instability

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22
Q

Which of the following can be a manifestation of delirium tremens?

  • Angioedema
  • Desquamative skin rash
  • Muscle spasms
  • Arthralgias
  • Nausea/vomiting
  • Palpable purpura
A

-Nausea/vomiting

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23
Q

During your assessment of a patient taking Morphine, which of the following side effects is most likely to be seen?

  • Biliary colic
  • Hypokalemia
  • Bloody diarrhea
  • Severe diarrhea
  • Mydriasis
  • Blurring of vision
A

-Biliary colic

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24
Q

During your assessment of a patient taking Morphine, which of the following side effects is most likely to be seen?

  • Decreased bone density
  • CNS stimulation
  • Insomnia
  • Nausea and vomiting
  • Hypokalemia
  • Tachycardia
A

-Nausea and vomiting

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25
Q

During your assessment of a patient taking Morphine, which of the following side effects is most likely to be seen?

  • Decreased glucose
  • Hypokalemia
  • Insomnia
  • Hypertension
  • CNS Stimulation
  • Increased intracranial pressure
A

-Increased intracranial pressure

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26
Q

During your assessment of a patient taking Morphine, which of the following side effects is most likely to be seen?

  • Tachycardia
  • Severe diarrhea
  • Mydriasis
  • Secondary biliary cirrhosis
  • Hypotension
  • Hypertension
A

-Hypotension

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27
Q

Which of the following is an antidote to acute opioid toxicity?

  • Succimer
  • Dimercaprol
  • EDTA
  • Flumazenil
  • Naloxone
  • Morphine
A

-Naloxone

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28
Q

Which of the following accurately describes the mechanism of action of Oxycodone?

  • Nondepolarizing neuromuscular blocking agent
  • NSAID
  • Opioid receptor antagonist
  • Opioid receptor agonist
  • Corticosteroid
  • Selective COX-2 inhibitor
A

-Opioid receptor agonist

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29
Q

Which of the following side effects is likely to be caused by Oxycodone?

  • Hyperuricemia
  • Tachypnea
  • CNS depression
  • Mydriasis
  • Ascites
  • Hypoalbuminemia
A

-CNS depression

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30
Q

Which of the following indications is most appropriate for Oxycodone?

  • Tonic-Clonic seizures
  • Refractory pain
  • Anesthesia induction
  • Local anesthesia
  • Mild pain
  • Labor pain management
A

-Refractory pain

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31
Q

Which of the following side effects is likely to be caused by Oxycodone?

  • Mydriasis
  • Respiratory depression
  • Hypercapnia
  • Tachypnea
  • Diarrhea
  • CNS excitation
A

-Respiratory depression

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32
Q

Which of the following best describes the use of epinephrine when used with lidocaine?

  • Antiarrhythmic effects extended with epinephrine
  • Anesthetic effects extended with epinephrine
  • Epinephrine improves drowsiness
  • Epinephrine acts as a bronchoconstrictor
  • Epinephrine decreases side effects
  • Avoid using epinephrine and lidocaine together
A

-Anesthetic effects extended with epinephrine

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33
Q

Which of the following is most likely a side effect associated with lidocaine?

  • Angioedema
  • Blurred vision
  • Seizures
  • Hyperkalemia
  • Thrombocytopenia
  • Euphoria
A

-Seizures

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34
Q

Which of the following is most likely a side effect associated with Lidocaine?

  • Acute dystonia
  • Hyperglycemia
  • Increased serum amylase
  • Drowsiness
  • Dysphoria
  • Crystalluria
A

-Drowsiness

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35
Q

Which of the following is a common indication for lidocaine?

  • Hypertensive crisis
  • Atrial fibrillation
  • Asthma
  • Seizures
  • Hypernatremia
  • Ventricular arrhythmia
A

-Ventricular arrhythmia

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36
Q

What is the mechanism of action of lidocaine?

  • Blocks Na+ channels
  • Blocks adenylyl cyclase
  • Blocks Ca2+ channels
  • Blocks Beta-1 receptors
  • Blocks Na+/K+ APTase
  • Blocks K+ channels
A

-Blocks Na+ channels

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37
Q

Which of the following describes a common clinical use of lidocaine?

  • Antihypertensive agent
  • Anesthetic
  • Beta blocker antidote
  • Extends anesthetic effects
  • Reversal agent
  • Drug for glaucoma
A

-Anesthetic

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38
Q

Which of the following is most likely a side effect associated with lidocaine?

  • Agranulocytosis
  • Melena
  • Depression
  • Cytoplegia
  • Pulmonary fibrosis
  • Respiratory depression
A

-Respiratory depression

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39
Q

Which of the following side effects is most likely associated with methotrexate?

  • Colitis
  • Retinal Angiomas
  • Dry beriberi
  • Macrocytic Anemia
  • Retinitis
  • Skin hyperpigmentation
A

-Macrocytic Anemia

40
Q

Which of the following side effects is most likely associated with Methotrexate?

  • Osteonecrosis of the jaw
  • Pink frothy sputum
  • Curling’s ulcer
  • Hepatitis
  • Bilirubin gallstones
  • Giant cell arteritis
A

-Hepatitis

41
Q

Which of the following is the most likely mechanism of action of Methotrexate?

  • Inhibits dihydrofolate reductase
  • Inhibits Topoisomerase I
  • Inhibits TNF-Alpha
  • Inhibits Ribonucleotide Reductase
  • Inhibits Topoisomerase II
  • Inhibits Xanthine Oxidase
A

-Inhibits dihydrofolate reductase

42
Q

Which of the following characteristics is most likely associated with Methotrexate?

  • Teratogenic
  • Ketogenic
  • Toxigenic
  • Myogenic
  • Pyogenic
  • Androgenic
A

-Teratogenic

43
Q

Which of the following is most likely an indication for Methotrexate?

  • CMV Retinitis
  • Medical abortion
  • Polymyalgia rheumatica
  • Infertility in males
  • Acute tubular necrosis (ATN)
  • Giant cell arteritis
A

-Medical abortion

44
Q

Which of the following is the best treatment option for myelosuppression associated with Methotrexate?

  • Leucovorin Rescue
  • Cyclosporine Rescue
  • Cyanocobalamin Rescue
  • Biotin Rescue
  • Niacin Rescue
  • Steroid Rescue
A

-Leucovorin Rescue

45
Q

Which of the following is most likely an indication for Methotrexate?

  • Anaerobic infections
  • Actinic Keratosis
  • Rheumatoid Arthritis
  • Agranulocytosis
  • CMV Retinitis
  • Giant cell arteritis
A

-Rheumatoid Arthritis

46
Q

Which of the following side effects is most likely associated with methotrexate?

  • Hemolytic anemia
  • Dermatomyositis
  • Angioedema
  • Flushing
  • Mucositis
  • Gingival hyperplasia
A

-Mucositis

47
Q

Which of the following is most likely an indication for methotrexate?

  • Hepatitis C
  • Diabetic Glomerulonephropathy
  • Gout disease
  • Gauchers disease
  • Cancer
  • Anaerobic infections
A

-Cancer

48
Q

Which of the following characteristics best describes methotrexate?

  • Pyimidine analog
  • Microtubule inhibitor
  • Folic acid analog
  • 30S inhibitor
  • Alkylating agent
  • Purine analog
A

-Folic acid analog

49
Q

Which of the following is most likely a sign or symptom of amphetamines intoxication?

  • Splenomegaly
  • Clay colored stools
  • Hypertension
  • Barrel chest
  • Cullen sign
  • Swollen gums
A

-Hypertension

50
Q

Which of the following is most likely a symptom of amphetamines intoxication?

  • Blood dyscrasias
  • Swollen gums
  • Painless chancre
  • Mydriasis
  • Splenomegaly
  • Cheilosis
A

-Mydriasis

51
Q

Diabetic Medications that are either weight-neutral or known for weight loss are:

A

Biguanides
Glucagon-like peptide-1 (GLP-1) receptor agonists
Amylin agonist
Dipeptidyl peptidase-4 (DPP-4) inhibitors
Sodium/glucose cotransporter 2 (SGLT2) Inhibitors (aka gliflozins)
Pramlintide (Symlin)

52
Q

What drug classes for the treatment of type 2 diabetes mellitus have been shown to reduce cardiovascular disease?

A

GLP-1 Receptor Agonists
SGLT-2 Inhibitors

**This was a student answer to a teacher question

53
Q

When would IV Levothyroxine be indicated?

A

IV administration is used for myxedema coma and for patients who cannot take levothyroxine orally for an extended period of time. IV doses are approximately 50% of the size of oral doses.

54
Q

How soon should you check thyroid function tests after starting a patient on Synthroid?

A

TSH levels do not normalize quickly and often lag behind normalization of serum T3 and T4. TSH should be re-evaluated 6-8 weeks after starting treatment

55
Q

What are the pharmacologic treatment options for a patient with hyperthyroidism?

A

Thionamides: methimazole & propylthiouracil (PTU)
Radioactive Iodine
Nonradioactive Iodine: Lugol

56
Q

What contraindication would prevent you from prescribing metformin for a patient?

A

Significant Renal Impairment due to risk for lactic acidosis

Metformin should not be used in patients predisposed to develop lactic acidosis such as decompensated CHF, liver failure, heavy alcohol use, or patients undergoing major surgery.

57
Q

What is the somogyi effect? What is the Dawn phenomenon

A

Both are periodic hyperglycemia events that happen to type 1 and type 2 diabetics in early dawn.
Somoygi effect is preceded by a hypoglycemic episode during the night time
Dawn phenomenon does not require hypoglycemia to illicit a hyperglycemia the following morning.

58
Q

Let us talk about hyperthyroidism. Full effects of Methimazole can take a few weeks to take effect because the medication blocks the formation of new thyroid hormone, it does not remove the thyroid hormone that is already in the thyroid and circulation. The mechanism of action is to block the production of thyroid hormone from the thyroid gland. Agranulocytosis is a rare side effect that can occur. Check WBC before initiating. Methimazole works faster than PTU. Use PTU in first trimester of pregnancy as methimazole crosses the placenta and may be teratogenic.

A
59
Q

Normal levels of TSH, free T3, and free T4:

A

TSH normal levels are 0.3-6 mIU/L

Free T3 normal levels are 230-620 pg/dL

Free T4 normal levels are 0.9-2 ng/dL

60
Q

What is the drug class of Venlafaxine? What is the mechanism of action?

A

Serotonin-Norepinephrine Reuptake Inhibitors

Venlafaxine blocks norepinephrine and 5-HT reuptake and a weak blocker of dopamine reuptake.

61
Q

What is the mechanism of action of tricyclic antidepressants, resulting in it’s beneficial and side effects?

A

Block the re-uptake of norepinephrine, serotonin (5-HT), histamine receptors, alpha-1 receptors, and acetylcholine receptors.

TCA (example, amitriptyline) are potent anticholinergics and antagonists at the histamine H1 receptors; by antagonizing the H1 receptor, sedation may occur. Antagonism of muscarinic acetylcholine receptors contributes to cognitive dulling as well as adverse effects mediated by the parasympathetic nervous system (blurred vision, dry mouth, tachycardia, constipation, difficulty urinating). Some tolerance does occur for these anticholinergic effects. Antagonism of alpha-1 adrenergic receptors contributes to orthostatic hypotension and sedation. Weight gain is another side effect of this class of antidepressants. The most dangerous adverse effect of TCA is cardiotoxicity which limits its use in patients with coronary heart disease. Prior to prescribing TCA, baseline ECG should be obtained and ECG monitoring while on this drug. (On page 222 of the Lehne’s textbook, check out the “Summary of key prescribing considerations for Tricyclic antidepressants).

62
Q

What are the indications for use of TCAs?

A 
Major depression
Fibromyalgia syndrome
Neuropathic pain
Insomnia
Attention Deficit Hyperactivity Disorder
Panic Disorder
Obsessive-compulsive disorder
63
Q

What are the indications for use for Venlafaxine?

A

Venlafaxine is approved for major depression, generalized anxiety disorder, social anxiety disorder and panic disorder.

64
Q

What are the adverse effects of venlafaxine?

A

Adverse effects of venlafaxine are nausea (most common), headache, anorexia, nervousness, sweating, somnolence, and insomnia. Dose-dependent weight loss may occur secondary to anorexia. Blood pressures should be monitored as Venlafaxine can cause dose-related sustained diastolic hypertension. Sexual dysfunction may occur.

65
Q

Explain Levodopa use in Parkinson’s Disease.

A

Levodopa is the metabolic precursor of dopamine. Levodopa is converted to dopamine in the brain through the direct activation of dopamine receptors. (see Lehne’s page 128-129)

Levodopa is converted to dopamine by decarboxylation primarily within the presynaptic terminals of dopaminergic neurons in the striatum. The dopamine produced in the presynaptic terminals is responsible for the therapeutic effectiveness of levodopa in Parkinson’s disease.

66
Q

What is the “wearing off” phenomenon with Levodopa use

A

A common problem is the development of the ‘wearing off” phenomenon. Each dose of levodopa improves mobility for up to 1-2 hours, but rigidity and akinesia return at the end of the dosing interval. Increasing the dose and frequency of administration can improve this situation, but this is limited by the development of dyskinesias, excessive and abnormal involuntary movements.

67
Q

What is the on/off phenomenon with levodopa use?

A

In late stages of PD, patients experience the on/off phenomenon where there is rapid fluctuation between being “off” having no beneficial effects from their medication and being “on” but with disabling dyskinesias.

68
Q

Adverse effects observed with levodopa treatment

A

In addition to motor complications and nausea, several other adverse effects are observed with levodopa treatment such as hallucinations, and confusions. Orthostatic hypotension - may be from the peripheral decarboxylation of levodopa and release of dopamine into the circulation may activate vascular dopamine receptors to produce orthostatic hypotension.

69
Q

What are cholinesterase inhibitors used for?

A

These drugs are approved by FDA for mild to moderate Alzheimer’s disease (AD) but not approved for severe AD except for donepezil, is also approved for those with severe symptoms.

70
Q

Adverse effects of cholinesterase inhibitors

A

Adverse effects that are common: nausea, vomiting, diarrhea, dyspepsia, dizziness.

Gastrointestinal side effects may be worse with rivastigmine, less with galantamine, and least with donepezil.

They all cause bradycardia which leads to patients fainting, falling and fall-related fractures. Weight loss is another possibility with these drugs, to prevent weight loss, encourage nutritional supplements, snacks between meals, or recommend dietician consults.

Donepezil may be associated with muscle cramps and sleep disturbance. It is contraindicated in patients with cardiac conduction abnormalities or gastric ulcer disease with a history of bleeding.

71
Q

What drugs can be used with behavioral disturbances associated with dementia?

A

There is convincing evidence that neuropsychiatric symptoms can be reduced with two atypical antipsychotics: risperidone (Risperdal) and olanzapine (Zyprexa)
Cholinesterase inhibitors may offer modest help.

There is little or no evidence for a benefit from conventional antipsychotics (haloperidol, chlorpromazine, mood stabilizers, antidepressants, or memantine.

72
Q

MAO-B (Selegiline & Rasagiline)

A

When these drugs are combined with levodopa, they reduce the wearing-off phenomenon of PD. The mechanisms of action of these two drugs are to preserve dopamine in the brain. When Selegiline and rasagiline are used alone, the benefits are modest despite being considered the first-line drugs for PD.

The isoenzyme MAO-B is mostly found in the striatum and is responsible for the oxidation metabolism of dopamine in the brain. Selegiline has been shown to lessen the adverse motor and cognitive effects of levodopa therapy. Selegiline has been used for symptomatic treatment for PD and is well tolerated in younger patients with early or mild PD. Metabolites of selegiline are amphetamine and methamphetamine which may cause anxiety, and insomnia. Additional adverse effects are orthostatic hypotension, dizziness, and GI upset.

73
Q

Why isn’t levodopa administered as monotherapy?

A

In clinical practice, levodopa is almost always administered in combination with a peripherally acting inhibitor such as carbidopa, as this drug do not penetrate well into the central nervous system. If levodopa is administered alone, less than 2% of the dose enters the brain and that is why a combination of levodopa and carbidopa called Sinemet is given. When carbidopa is administered, the inhibition of peripheral decarboxylase reduces the incidence of GI side effects from levodopa and allows more levodopa to cross the blood-brain barrier where the conversion of levodopa to dopamine takes place. (found on page 131 of the Lehne textbook)

Stalevo - Entacapone is combined with Sinemet to treat the end-of-dose wearing off symptoms of PD. Entacapone is a catechol-O-methyltransferase-COMT inhibitor (COMT). (Lehne’s pages 128-133 for more info).

74
Q

Parkinson’s Medications

A

Both selegiline and rasagiline when taken with foods containing tyramine may cause hypertensive crisis, and when given with certain drugs like the selective serotonin reuptake inhibitors may potentially cause serotonin syndrome.

Two orally administered dopamine receptor agonists commonly used for PD treatment are ropinirole and pramipexole.

Amantadine, an antiviral drug used for the prophylaxis and treatment of influenza A, has antiparkinsonian activity. Amantadine appears to alter dopamine release in the striatum, has anticholinergic properties, and blocks NMDA glutamate receptors.

75
Q

Selegiline (Zelapar)

A

A medication that can be used as adjunctive therapy in a patient taking Sinemet is Selegiline (Zelapar) which is a selective MAOI (MAO-B Inhibitor). By taking Selegiline with Sinemet it can help to prolong the effects of levodopa and decrease fluctuations in motor control. One important thing to remember is that a patient should never take a nonselective MAOI and Sinemet as this can cause a hypertensive crisis.

76
Q

Donepezil

A

Donepezil is typically taken once daily in the evening with a starting dose of 5 mg. One thing that we need to remind our patients and caregivers is that this is not a cure but will help to slow the progression of the disease process. Acetylcholinesterase inhibitors, such as donepezil, work by preventing acetylcholine from being broken down. Acetylcholine is also found in other areas of the body, so these medications in this class may have unwanted effect. Typically, the side effects are mild. The most common adverse effects are nausea, vomiting and diarrhea. Other adverse effects are bradycardia, fainting, falls, and fall related fractures. This drug is contraindicated in a patient with a history of heart block. In some patients, the drug may not improve their memory. We must educate the patients and caretakers about this before prescribing.

77
Q

What laboratory tests should be ordered for a patient on Lithium?

A

Some important laboratory tests to order would be to monitor lithium serum levels, renal function, and thyroid function.
Adequate Lithium serum levels should be between 0.6 and 0.8 mmol/L.
Renal function can decline with Lithium use
Thyroid function may be affected using lithium, causing hypothyroidism or a goiter.
Vitals and weights need to also be monitored on a patient who is on Lithium

(Student Answer)

78
Q

What are the adverse effects and patient education for the drug Atomoxetine?

A

Atomoxetine/Strattera is a selective norepinephrine reuptake inhibitor. This medication works by increasing the norepinephrine levels in the brain. This medication is used to treat attention deficit hyperactivity disorder and also has antidepressant effects. This medication helps increase the attention span in patients with ADHD. It is important to tell the patient it may take up to two weeks for the medication to take full effect.

Atomoxetine is not a controlled substance and it is not a stimulant like other ADHD medications. It is important to teach patients that they should not take this medication with alcohol which can increase the adverse side effects.

This medication is used in patients with ADHD who cannot tolerate the stimulant medications used to treat ADHD. A serious side effect in children and adolescents is increased risk for suicidal ideation. Other side effects include sedation, insomnia, dizziness, headaches, nausea, and vomiting.

(Student Answer)

79
Q

Why is a patient experiencing alcohol withdrawal given a benzodiazepine?

A

(NO ANSWER PROVIDED, HAVEN’T LOOKED IT UP YET)

80
Q

What are some common side effects a patient may experience when taking a SSRI?

A

(NO ANSWER PROVIDED, HAVEN’T LOOKED IT UP YET)

81
Q

What are some signs/symptoms and laboratory changes we would see in a patient with lithium toxicity?

A

If a patient has a lithium toxicity they will experience weakness, poor concentration, ataxia, and mild tremors. If the toxicity increases the patient will experience increasing tremors, confusion, and lethargy. Lithium causes so many intolerable side effects patients tend to be non-compliant with the medicine. Lithium has adverse effects on the kidneys, thyroid and parathyroid gland. Regular lab tests are necessary to determine kidney, thyroid, and parathyroid function. Lithium can cause hypothyroidism and hyperparathyroidism.

(Student Answer)

82
Q

What are the best options for a menopausal female that is having severe hot flashes?

A

The primary treatment for treating hot flashes among post-menopausal women or s/p hysterectomy would be estrogen hormonal replacement therapy such as Estrogen. For patients that still have their uterus, progesterone is normally added to prevent uterine cancer.

Other FDA approved nonhormonal therapy for hot flashes would antidepressant such as low-dose form of Paroxetine (Brisdelle). Anti-seizure medications such as Neurontin and Lyrica may also be used and nerve block procedures for moderate to severe hot flashes may also be an option

(STUDENT ANSWER)

Mild hot flashes can also be treated with supplements such as flaxseed, black cohosh, etc. (TEACHER COMMENT)

83
Q

Please discuss the treatment options for COPD based on severity

A

Bronchodilators are drugs to help open the airways. Most bronchodilators are metered-dose inhalers, and some are available as nebulizers. Bronchodilators are categorized into two groups, short-acting beta-agonists (SABA) and long-acting beta-agonists (LABA).
Other forms of short-acting agents, such as short-acting muscarinic antagonists (SAMA), are helpful if the symptoms are mild and infrequent.
Long-acting bronchodilators are used for chronic conditions. Glucocorticoids have anti-inflammatory effects and are prescribed with bronchodilators if bronchodilators alone are not effective. Glucocorticoids, in combination with bronchodilators, are also prescribed for flare-ups and COPD exacerbations. Glucocorticoids are not administered for long-term treatment.
Roflumilast is a pill prescribed for people with chronic cough and phlegm production (chronic bronchitis) and frequent exacerbations despite using inhaled bronchodilators and glucocorticoids. Theophylline may be used to help with shortness of breath.
It is worth mentioning that cough medicines are not used to control COPD even when the cough is present.
Examples of SABA include Albuterol and Levalbuterol. Ipratropium is a SAMA agent. Salmeterol and Indacaterol belong to LABA (STUDENT ANSWER).

84
Q

How does the selective estrogen receptor modulator, Evista, work for patients with osteoporosis? What are some major side effects to watch out for?

A

Raloxifene, Evista, is structurally similar to estrogen, so can bind to estrogen receptors. Unlike Estrogen, which is an agonist in all tissues, SERMs are agonists in some tissues and antagonists in others.
Raloxifene mimics the effects of estrogen on bone, lipid metabolism, and blood clotting and blocks estrogen effects in the breast and endometrium.

Raloxifene increases bone mineral density and reduces risk of fractures

Adverse effects: Thromboembolic events. Like estrogen, raloxifene increases the risk for DVT, PE, and stroke. Other adverse effects include weight gain and hot flashes.

85
Q

Inhaled Glucocorticoids

A

Inhaled glucocorticoids are the most effective asthma medications that we have for long term control of this airway inflammation present in Asthma. The dosing of these medications depends on the stage of Asthma. Inhaled steroids are much safer to use than oral steroids. According to our textbook there is some conflicting information about using inhaled steroids daily in COPD - they state that typically in COPD these meds are used in exacerbations.

We need to educate these patients that they must take these medications on a consistent and daily basis. Most common adverse effects are thrush (oropharyngeal candidiasis) and issues with the voice (dysphonia - hoarseness/difficulty speaking). We need to teach patients to rinse the mouth out with water and gargle after using inhaled steroids to help negate these side effects. Also, they may try to use a spacer which can also help these symptoms and increase the delivery of aerosolized drug to the lungs.

Long term inhaled corticosteroid use at a high dose can lead to some adrenal suppression but is usually low. They can slow the growth in children and adolescents (this has been shown to be “mild”). Long term use can also promote bone loss, immune suppression, and may cause glaucoma and cataracts.

86
Q

If a patient has open angle glaucoma and also has a history of a respiratory disorder, which ophthalmic solution would be safe to use?

A

Betaxolol

87
Q

What does estrogen do in the body? What does progesterone do?

A

Estrogen in particular acts everywhere on the body that includes parts of the brain, and the effect serotonin has. This modifies the production of a hormone that effects endorphins in the brain. In females, it also plays various roles in the body and helps to develop and maintain both the reproductive system and female characteristics such as breasts and pubic hair. It also contributes to cognitive health, bone health, the functioning of the cardiovascular system. The ovaries, adrenal glands and fat tissues produce estrogen. There are three types of estrogen including estrone, estradiol, which is most common in reproductive years, and may result in acne, loss of sex drive, osteoporosis, and depression. Very high can result in uterine and breast cancer, where too low can result in weight gain and cardiovascular disease. Estriol is a form of estrogen produced in the body for uterine growth and delivering a baby. Estrogen helps stimulate the growth of egg follicles, maintain the thickness of the vaginal wall, and promote lubrication, it works in the uterus to enhance and maintain the mucous membrane that lines the uterus, and works in the breast to form breast tissue.
Estrogen is often combined with progestin for menstruation and in combination birth controls. Progestin helps to properly regulate the menstrual cycle and treat unusual stopping o the menstrual periods. It can also help pregnancy to occur during egg donor or infertility procedures and can prevent estrogen from thickening the lining of the uterus (Regidor, 2018). It is a hormone that regulates the development and function of the uterus and regulate transcription of specific genes in uterus.

88
Q

How frequently is medroxyprogesterone given to a patient?

A

Medroxyprogesterone is a long-acting reversible contraception (LARC) option. LARCs are contraceptive options that are administered less frequently than monthly but are not permanent forms of contraception. Other options in this category include the copper intrauterine device (IUD), levonorgestrel intrauterine device (IUD), and the subdermal etonogestrel implant. These are considered the most effective methods of contraception.

Depot medroxyprogesterone acetate (DMPA), also known as Depo-Provera, is given via subcutaneous or IM injection and can protect against pregnancy for 3 months or longer. DMPA inhibits follicular maturation and ovulation. It also causes changes to the cervical mucus and endometrial lining that make implantation of fertilized ovum unlikely.

DMPA is a progestin-only contraceptive option and has similar adverse effects to other types of progestin-only options. These include irregular or abnormal menstruation, mild weight gain, headaches, depression, and decreased libido.

89
Q

Methylxanthines

A 
Methylxanthines are medications used to treat asthma and COPD
These types of medications help promote bronchodilation, therefore ease of breathing and respiratory drive
Common examples of this class of medications include Theophylline and Aminophylline
Adverse effects such as nausea and vomiting, abdominal pain, anxiety, and palpitations must be reported to the provider, as these symptom(s), if experienced, may indicate medication toxicity
90
Q

Which medications are used for exercised-induced bronchospasm (EIB)?

A

Medication that can treat this consists of short-acting beta-2 agonist like albuterol or levalbuterol, leukotriene receptor agonist like Singular or Zyflo
Teaching that I would give these types of patients is that if you are being treated with the leukotriene receptor agonist then you should take that medication greater than two hours before you exercise to prevent the bronchospasms; if they are prescribed the short-acting beta-2 agonist that is inhaled then they should begin this treatment anywhere between five to thirty minutes before exercise to give the medication time to start working before you exercise

(STUDENT ANSWER)

91
Q

Which glucocorticoid has the greatest anti-inflammatory potency when administered systemically?

A

NO ANSWER PROVIDED

92
Q

What condition is the medication Zafirlukast used for? What is the mechanism of action?

A

Zafirlukast (Accolate) is an anti-asthma medication is used for chronic treatment as well as for prophylactic purposes.
Zafirlukast is a leukotriene receptor antagonist; it works by disrupting the inflammatory pathway that is involved in the etiology in asthma and allergic rhinitis. It inhibits bronchoconstriction in the early phase and later phase of asthma.
It is largely metabolized in the liver by cytochrome P450 (CYP2C9) that the risk of hepatotoxicity is higher. Common side effects for this medication are nausea, diarrhea, dyspepsia, abdominal pain dizziness, headaches, myalgia and fever
Caution is advised for patients who are hepatic impaired

93
Q

When we prescribe an inhaled corticosteroid such as Fluticasone (Flovent) or Budesonide (Pulmicort), what are some things that what need to educate our patient about?

A

Patients should be aware that inhaled corticosteroids when used long-term and highly dosed, carry a risk for adrenal suppression which may present with mental changes, low blood pressure, and hypoglycemia. Adrenal suppression is more concerning in young children with a low BMI who have used the inhaled glucocorticoid for over 6 months. There is also slowed growth in children but not a change in their final adult height.
Other long-term use effects are the risk of bone loss, cataracts and glaucoma, dysphonia, and oropharyngeal candidiasis. Teaching and informing patients about adequate calcium, vitamin D, and weight-bearing exercises may help prevent bone loss (osteoporosis). Counseling on the importance of rinsing their mouth and gargling after inhalation will help lessen the effects of dysphonia and oral thrush. Technique assessment and teaching may help improve medication delivery which will deliver a better therapeutic effect.

94
Q

How does Cromolyn work and what class of medication does it fall under? What is it used for?

A

NOT YET ANSWERED

95
Q

How does Ipratropium work in the treatment of Asthma? What are side effects to watch out for?

A

NOT YET ANSWERED

96
Q

How does Montelukast work in the treatment of Asthma? What are side effects to watch out for?

A

NOT YET ANSWERED

FNP (5 decks)

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