Pharmacology Flashcards
1
Q
What medication is a contraindication for a patient with gout?
A
Thiazide diuretic INCREASE uric acid levels
2
Q
What are PharmaKinetics changes in the older patient populations?
A
- Increase in fat to water ratios
2. Decrease in albumin, plasma protein, liver blood flow, liver size, CYP450 enzyme pathways, and GFR.
3
Q
A NP knows that a certain drug slows down drug clearance. What does the NP look for?
A
Drug overdose - Over medication
4
Q
A NP finds NSAIDS on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
reducing the renal blood flow and will damage kidneys further.
5
Q
A NP finds ACEI on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
increase risk of hyperkalemia
6
Q
A NP finds WARFARIN on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
Increase the risk of over-coagulation (INR>4).
Severe CKD and ESRD at risk for hemorrhagic complications.
7
Q
A NP finds LITHIUM on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
Increase risk for kidney injury
8
Q
A NP finds contrast dye on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
Injure kidneys
9
Q
A NP finds potassium-sparing diuretics on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
increase risk for hyperkalemia
10
Q
A NP finds sodium- phosphate (used of bowel prep) on the medication profile for a patient. A NP knows this will affects patients with CKD by
A
FDA 2019 WARNING
may cause sudden loss of kidney function as well as blood mineral disturbances.
11
Q
Drugs that slow down drug clearance, will increase risk for drug overdose. Which drugs inhibit the CYP450 system?
A
- Macrolides
- Antifungals
- Phenytoin
- Cimetidine
- Citalopram
- Protease inhibitors (- inavir)
- Grapefruit
12
Q
Your patient informs you that their favorite juice is grapefruit juice. What do you know as a NP about grapefruit juice and drug interactions?
A
Statins, erythromycin, CCB, antivirals, amiodarone, benzodiazepines, cisapride, carbamazepine, and buspirone
13
Q
Your patient is on Digoxin. What do you monitor?
A
Digoxin level, potassium, calcium, magnesium, EKG, creatinine
14
Q
Your patient is on Lithium. What do you monitor for?
A
Lithium levels, and TSH
Patient is at risk for developing hypothyroidism on medication.
15
Q
Your patient is on H2 Antagonist. What are some safety issues you need to know?
A
Patients with kidney disease may experience mental changes.
Do not prescribe if the creatine clearance is <50mL/minutes
16
Q
Your patient is on PPI. What are some safety issues you need to know? What can it cause with prolong use?
A
Post-menopausal women are at risk for fractures. Can cause PNA C-diff Low Magnesium Malabsorption of B12 and iron Atrophic gastritis Kidney disease
17
Q
What drugs interact with PPIs?
A
Warfarin Diazepam Carbamazepine Phenytoin Ketoconazole
18
Q
Your patient is on Vitamin K Antagonist. What are some safety issues you need to know?
A
LOOK OUT FOR 4 G herbs. Make sure to ask about medications and herbs taken at home.
- garlic
- gingko
- ginseng
- ginger
Make sure to DC 7 days before surgery
Avoid Green leafy vegetables and mayonnaise
19
Q
Your patient is on thiazolidinediones (TZDs) . What are some safety issues you need to know? BLACK BOX WARNING
A
BBW: Cause or exacerbate CHF. If the patient scores CLASS II or IV for the HF. DO NOT USE
Contraindications:
Hx of CHF, MI, STROKE, bladder cancer, DM-1, Eye disease, liver disease.
20
Q
Your patient is on ACTOS. What symptoms would warrant the NP to discontinue this medication?
A
HF:
Dyspnea, weight gain, cough
21
Q
Your patient is on atypical psychotic. What are some safety issues and educational topics you need to know?
A
Education that the medications will cause weight gain.
Can cause metabolic syndrome, DM2
Monitor for weight gain for the 1st 3 months
22
Q
Your patient is on atypical psychotic. What will the NP monitor for?
A
Weight gain by measuring the body mass index Blood glucose Hgb A1C TSH Lipids
23
Q
Your patient is on atypical psychotic. Name 3 drugs. What is the BLACK BOX WARNING?
A
- risperidone
- olanzapine
- quetiapine
BBW: higher mortality rate in the elderly
24
Q
What are the contraindications for bisphosphonates?
A
Bisphosphonates cause erosive esophagitis
Active GI disease such as GERD or PUD
CKD
Esophageal strictures or varies.
25
Your patient is on STAINS. What are some safety issues you need to know?
Do not mix with grapefruit juice. Drug-induced hepatitis,
With -AZOLE antifungals can cause rhabdo.
Chinese descent: increase risk for rhabdo especially taken niacin.
Increase Kinase levels
26
A patient is on a -statin. What s/s would be indicative of rhabdo?
muscle weakness, muscle pain, muscle tenderness, brown or dark red urine.
27
A patient is taking lincosamides. What to monitor for?
Cleocin
high risk for c-diff
28
Your pediatric patient is on an inhaled corticoid steroid. What are some safety issues you need to know?
Children: can cause adrenal insufficiency if on longer than 6 months
Target: High doses with children with low BMI
Monitor for growth retardations
29
What is some s/s of adrenal insufficiency?
Hypoglycemia, hypotension, altered mental status, weakness, Cushingoid features)
30
A patient is on systemic glucocorticoids? What would cause CAUTION and safety issues?
Patients with cataract, osteoporosis, skin changes (telangiectasia, easy bruising), weight gain high BP
31
A patient is on phenytoin? What would cause CAUTION and safety issues?
Monitor for toxicity- horizontal nystagmus, unsteady gait, WORSENS with slurred speech, lethargy, confusion, coma
Education patient on gingival hyperplasia
32
What are the BEERS CRITERIA used for ?
Provide guidance regarding medications that should be AVOIDED for patients over 65 y/o
33
According to the BEERS CRITERIA, what medications should be avoided for sleep in patient older than 65 y/o.
First generation antihistamines may cause dizziness which will lead to falls.
1. diphenhydramine
2. doxylamine
3. chlorpheniramine
34
According to the BEERS CRITERIA, what antipsychotics should be avoided in patient older than 65 y/o.
quetiapine
clozapine (Clozaril)
pimavanserin
USE WITH CAUTION
35
According to the BEERS CRITERIA, what anticoagulation should be avoided in patient older than 65 y/o.
Rivaroxaban
Dabigatran
Why? higher risk for bleeding than warfarin and other direct oral anticoagulants.
36
According to the BEERS CRITERIA, what does tramadol put patient over than 65 y/o at risk for.
Hyponatremia from SIADH
37
According to the BEERS CRITERIA, what does Opioids put patient over than 65 y/o at risk for.
Severe respiratory depression with BENZO and gabapentinoids.
38
What is the second-third line of drug to treat heart failure with a reduced ejection fraction?
DIGOXIN
39
What is the therapeutic range for digoxin?
0.5-2.0
40
Which plants put a patient at risk for cardia glycosides poison?
foxglove, oleander, and lily of valley
41
What are the s/s of a digoxin overdose?
GI (nausea/vomiting)
Hyperkalemia
Brady-dysrhythmias (atrioventricular [AV] blocks)
Tachydysrhythmias (ventricular tachycardia/fibrillation)
Atrial tachycardia with 2:1 block
Confusion
Visual changes (yellowish-green–tinged color vision).
42
What is the antidote for digoxin overdose?
Digoxin-specific antibodies
IgG antidigoxin antibodies
Digibind
DigiFab
43
What do you treat antiphospholipid syndrome?
Warfarin
(Antiphospholipid syndrome: An autoimmune disorder in which the immune system mistakenly produces antibodies and attacks the normal proteins in the blood. This results in increased risk of blood clots in legs, kidneys, lungs and brain.)
44
The NP is dosing a patient for Warfarin. What do the NP know about initial dosing?
ONSET 24-72 hours BUT it will take 5-7 days to reach the therapeutic range, therefore you will need a bridging agent such as Lovenox SUBQ (CARDS MD initiates it).
45
FOR atrial fibrillation, DVT, stroke/CVA what is the INR range?
2.0 to 3.0 (ideal INR 2.5)
46
For mechanical mitral valves (lifelong anticoagulation), what is the goal INR?
2.5-3.5
| ideal 3.0
47
A patient has mechanical prosthetic valve, what should the NP expect?
Dual therapy -Concurrent
| ASA and Warfarin
48
A NP expect an increase in INR after ...
The INR will increase 2 to 3 days after the first warfarin dose
49
A patient is on Warfarin therapy. What is the follow-up for Consistently Stable INR?
Check every 2 to 4 weeks up to every 12 weeks.
50
A patient is on Warfarin therapy. What is the follow-up for Single Out-of-Range INR?
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above therapeutic INR (2–3), experts suggest continuing current warfarin dose.
Retest INR within 1 to 2 weeks.
51
A patient is on Warfarin therapy. What is the follow-up for INR <5 With No Significant Bleeding Risk?
Omit one dose
Reduce maintenance dose slightly
Re-check INR.
52
Your patient reports eating green leafy vegetables while on Warfarin. What will the NP expect on lab work?
High intake of vitamin K will reduce anticoagulant effect of warfarin (will decrease INR)
FOODS: kale, spinach, collards/mustard/beet greens, broccoli raab, Mayonnaise, canola oil, and soybean oil
53
What is other another name for Vitamin K?
phytonadione
54
How would a NP educate a patient on Warfarin about alcohol usage?
Avoid drinking or limit to no more than one or two servings occasionally
Increases risk of bleeding even if INR is in target range.
55
What is rare reaction to Warfarin?
Purple toes syndrome” (rare)
Skin necrosis located in subcutaneous fat, breasts, extremities, trunk (within first few days of receiving large doses of warfarin), bleeding
56
Direct Oral Anticoagulants
1. Direct thrombin inhibitors
2. Direct factor Xa (FXa) inhibitors
1. Direct thrombin inhibitors
(dabigatran)
2. Direct factor Xa (FXa) inhibitors
(apixaban, rivaroxaban, betrixaban, edoxaban)
57
What are the reversal agents for Dabigatran (Pradaxa)?
idarucizumab (Praxbind)
58
What are the reversal agents for Rivaroxaban (Xarelto), and apixaban (Eliquis)?
andexanet alfa (Andexxa)
59
There is no antidote for Plavix, but you can give ...
Fresh frozen plasma or cryoprecipitate
60
Patient is experiencing salicylate overdose. NP knows the wait time is ...
After taking aspirin, it takes 4 days for the platelet function to return to normal
61
Ketorolac (Toradol) cannot be used over ________ days.
5 days
62
What treats dysmenorrhea?
Naproxen (Aleve, Naprosyn)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin)
Mefenamic acid (Ponstel)
63
Gingko biloba, garlic, ginseng, fish oil, feverfew, Dong quai
What education should be given to the patient on this herbal therapy?
Increase bleeding risk, especially if taken in high doses
advise patient to stop taking approximately 7 days before surgery
64
What is a consideration for dosing Warfarin to patient that are sensative to dose adjustments?
Asian patients may require lower starting and maintenance doses of warfarin.
Some genotypes require lower doses of warfarin (genetic testing is available)
Persons older than 60 years are more likely to have larger increases in INR (after dose is increased) compared with younger patients.
65
A patient is allergic to sulfa medications. Which ones should be discontinued?
https://en.wikipedia.org/wiki/List_of_sulfonamides
66
Thiazide Diuretics is contraindications
Lithium use and sulfa allergy
67
Thiazide diuretics have many adverse effects. How can it affect a patient's lipid panel?
Elevates cholesterol and low-density lipoprotein (LDL)
| Careful if preexisting hyperlipidemia
68
Why would a NP use a thiazide diuretic to treat Hypertension accompanied by osteopenia or osteoporosis?
Thiazide diuretics reduce calcium excretion by the kidneys and stimulate the osteoblasts. This helps build bone.
69
Potassium-Sparing Diuretics BBW!!!
Triamterene and Amiloride
Black box warning: Hyperkalemia, which can be fatal; higher risk with renal impairment, diabetes, elderly, severely ill
70
Mineralocorticoid Receptor Antagonists BBW and AE?
Spironolactone and Eplerenone
Black box warning: There is increased risk of both benign and malignant tumors.
Spironolactone adverse effects: Gynecomastia (13%) and hyperkalemia
71
What are the Loop Diuretics BBW?
Black box warning: Excessive amounts of furosemide may lead to profound diuresis; medical supervision required, individualized dose schedule
72
Can a patient on Lasix experience pancreatitis, jaundice, and rash while taking the medication?
YES, because they are adverse effects
73
A diabetic patient starts a beta-blockers medication for migraine prophylaxis. What should her education include regarding diabetes and beta-blockers?
Blunts hypoglycemic response (warn diabetic patients to initially monitor blood sugars more often)
74
A patient abruptly stopped taking their beta blocker. What should the NP look for?
sinus tachycardia, high BP. and angina
75
What change in conditions should monitor in the elderly when starting them on a beta-blocker?
hypotension, depression, fatigue
76
Direct Renin Inhibitors are _____________. What are the contraindications?
```
Contraindications
Concomitant use of ACEI or ARBs, especially in diabetic patients (risk of kidney injury, hypotension, hyperkalemia)
angioneurotic angioedema
pregnancy/breastfeeding
age <6 years
renal artery stenosis
```
Aliskiren (Tekturna), aliskiren/HCTZ (Tekturna HCT)
77
What is Entresto? What are the indications?
CLASS: Neprilysin Inhibitors and Angiotensin II Receptor Blockers
NAME: Sacubitril and valsartan
USE: Adult HF (NYHA Class II-IV) and pediatric HF (age >1 year)
78
Entresto BBW
Black box warning: Fetal toxicity; drugs that act on the renin–angiotensin system can cause injury or death to the developing fetus; if pregnancy detected, discontinue as soon as possible
79
Entresto contraindications
history of angioedema, regardless of cause.
80
Entresto adverse effects
```
Hypotension
Hyperkalemia
Angioedema
Dizziness
Cough
```
81
How does Alpha-Blockers (Alpha-1-Adrenergic Antagonists) work on BPH? -zosin
Relaxes smooth muscles on the bladder neck and the prostate and improves symptoms of benign prostatic hypertension (BPH)
82
Alpha-Blockers can be used to treat BPH and HTN. There are only two drugs this class that can lower BP? Which are ...
Terazosin (Hytrin): Can lower BP and treat BPH
| Doxazosin (Cardura): Can lower BP and treat BPH
83
Alpha-Blockers should not be use if the patient has ....
Do not give during cataract/glaucoma surgery will cause floppy iris syndrome.
84
Tamsulosin (Flomax) is started. What education should be given to the patient about safety?
Tamsulosin (Flomax) on initial dose may cause a vasovagal response, bottoming out the BP.
Patients need to be warned that someone should be with them when initiating therapy.
Priapism
85
T or F
| Alpha-blockers are not first-line choice except for males with both hypertension and BPH.
False. It is first line
86
When does Sudden Cardiac Death occur, in the United States?
* More likely to occur in the morning between 7 a.m. and 9 a.m. (70% higher).
* Day of the Week: Monday
* Season: Winter
87
A NP knows that a direct renin inhibitor such as Aliskiren, cannot be combined with _________________ and ___________.
ACEI and ARBS
| -PRIL and -SARTAN
88
What is the BBW for ACEI?
Black box warning: ACEIs can cause death/injury to the developing fetus.
These are not to be used during pregnancy, as these drugs damage the developing fetal renin-angiotensin system and can lead to death.
89
Why would a NP order ACEI for hypertension with diabetes?
Renal protection
90
A NP knows that the contraindications for ACEI and ARBS are?
```
Pregnancy
Renal artery stenosis
Angioedema
Hyperkalemia (>5.5 mmol/L)
Hypersensitivity to the drug
```
91
Aliskiren and sacubitril/valsartan cannot be given to patient with a history of angioedema. The NP needs to switch them to an ACEI. What is the wait time between going to an ACEI or switching from ACEI?
3 days
92
True or False
Diabetics should avoid concomitant use of sacubitril/valsartan with aliskiren
True
93
ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of what
Mild to Moderate kidney failure with HTN
| Diabetics with HTN
94
What is the first line of therapy for Heart failure patients with a reduced ejection fraction?
ACEIs are first-line therapy for HF with left ventricular dysfunction (or HFrEF).
95
The NP has a patient on Captopril. What should be monitored for and why?
Order: CBC with DIFF
Captopril is associated with agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).
96
Can a breastfeeding mother have an ACEI or ARB?
Captopril is associated with agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).
97
What is the pathophysiology of the cough associated with ACEIs?
ACEI-induced cough and angioedema are caused by inhibition of the metabolism of bradykinin and kallikrein system, which are involved in the inflammatory process.
98
A NP have a patient with high risk for AKI or hyperkalemia. The NP just started a hypertensive medication that acts of the RAAS. When is the follow up to check for kidney function?
Check kidney function 3 to 5 days after starting the drug.
99
Calcium Channel Blockers (Calcium Antagonists) are used in the following conditions:
```
Hypertension
Angina pectoris
Coronary artery spasms
Supraventricular dysrhythmias
Pulmonary hypertension
Hypertrophic cardiomyopathy
Raynaud’s phenomenon (first line)
```
100
Dihydropyridines and Nondihydropyridines CCB are different because ____
Dihydropyridine (DHP) CCBs tend to be more potent vasodilators than non-dihydropyridine (non-DHP) agents, whereas the latter have more marked negative inotropic effects.
101
A NP needs to prescribe a ABT to a patient that is on Verapamil. What ABT is contraindicated?
Do not mix with erythromycin and clarithromycin (drug interaction).
102
A NP needs to prescribe a ABT to a patient that is on Verapamil. What ABT is contraindicated?
Do not mix with erythromycin and clarithromycin (drug interaction).
103
Verapamil and Cardizem should not be given with which heart conditions?
2nd-3rd Heart Block
Bradycardia
Heart Failure with a reduced ejection fraction
104
A patient develops pedal edema while on a CCB. What should be included in the care and education?
Pedal edema may occur with nifedipine and amlodipine because of vasodilation. If it bothers patient, reduce dose or take it later in the day. The pedal edema is positional and improves when laying down.
105
TRUE or FALSE
| Hypotension and bradycardia are the main symptoms of CCB poisoning
TRUE
106
What ABT increase Warfin levels?
SULFA
107
Capsaicin Crease can use to treat other two diseases
Trigeminal neuralgia and post hermetic neuralgia
108
ASA irreversibly suppress platelet function for up to ______ days
7
109
When to avoid NSAIDS?
In patients with CHF, GI bleeding, and kidney disease
110
ST. JOHN WARTS activates the enzymatic pathways in the liver. This decrease in drug levels. A NP will believe the patient to be under-medicated. Which medication would cause this interaction with St. John’s warts?
Antiretrovirals
Contraceptives
Cyclosporine
SSRI and SSNI — will cause serotonin syndrome
111
What drugs interact with macrolide?
Anticoagulant
Digoxin
Theophylline
Selected Stains
112
What are the gram positive bacterias?
Strep
Staph
Enterococcus
113
What is the contraindication for fluoroquinolones?
Less than 18
Pregnancy
Breastfeeding
Myasthenia gravis
114
What are the contraindication for sulfonamide?
G6PD anemia
Newborns
Infants < 2 months
HIV patient watch for Steven-Johnson
115
What eye concerns is associated with Digoxin?
Overmedication can cause
Yellow-to green
Blurred vision
Halos
116
What are the vision change concern associated with the usage of ETU and linezolid?
Optic neuropathy
117
A patient is on prolong use steroid use. What are some concerns pertaining to the patient eyes?
Cataracts
Glaucoma
Optic neuritis
118
What vision changes can occur while taking fluoroquinolone?
Retinal detachment
119
Patients taken ED medication can experience what visual changes?
Cataract
Blurred Vision
Ischemic optic neuropathy
120
What vision changes does a person taking Accutane have to watch out for?
Decrease night vision
| Cataract
121
What vision changes does a person taking Topamax may experience?
Acute-angle-closure glaucoma
ICP
Mydriasis
122
A person taking Plaquenil may experience what different eye changes
Neuropathy
| Permanent loss of vision
123
What is the vitamin D daily allowance?
32 oz milk for infants
Infants 400 IU
1-70. 600 IU
>70 800IU
124
When do we avoid given tetracyclines?
Pregnancy and patient younger than 9 y/o
125
A patient has s MRSA skin infection. How to treat
First line : Bactrim DS
Doxycycline, Minocycline, Clindamycin
126
Patient comes in with a non-MRSA skin infection. How to treat?
Cephalexin and Dicloxacillin
127
How to treat cystitis?
Augmentin
128
How to treat kidney infection?
Cephalexin or Cefdinir
129
Patient has otitis media or rhinosinitis. What are the first and second lines of treatment?
1. Amoxicillin
2. Augmentin
Depend if the patient is pediatric or adult
130
How to treat UTI for patients allergic to sulf medication?
Cipro
131
How to treat patient with travelers’ diarrhea
Cipro
132
How to treat patients with anthrax ?
Cipro and Anthrax vaccine
133
How to treat bacterial conjunctivitis ?
OCUflox
Quinolone drug
134
What are the commonly use sulf medications
```
HTZ, lasix
Sulfonylurea used in diabetes
COX2 inhibitors
Dapsone
Microbid
Sulfasalazine
Silvadene
```
135
A patient has a UTI. What are the contraindication for Batrim DS.
```
G6PD anemia
Newborns
Infants
younger than 2 months
Pregnancy
```
Patients on Warfarin
