Pharmacology Flashcards
The following are some “problematic” drugs. These drugs are responsible for a large number of drug–drug interactions.
Macrolides (erythromycin, clarithromycin, telithromycin)
Antifungals (ketoconazole, fluconazole, itraconazole)
Cimetidine (Tagamet)
Citalopram (Celexa)
Protease inhibitors (saquinavir, indinavir, nelfinavir)
Grapefruit juice
Atypical antipsychotics
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
what do you monitor
High risk of weight gain, metabolic syndrome, type 2 diabetes; monitor weight every 3 months
Black box warning: Higher mortality in elderly patients
Monitor TSH, lipids, blood glucose/A1C, weight/body mass index
Bisphosphonates
Alendronate (Fosamax)
Risedronate (Actonel)
Erosive esophagitis (chest pain with eating, odonophagia, dysphagia, heartburn), stop immediately if symptoms of esophagitis (chest pain, difficulty swallowing, burning midback) or jaw pain (osteonecrosis); take alone upon awakening with 8-oz glass water (not juice) before breakfast; do not lie down for 30 minutes afterward; do not mix with other drugs
Contraindications: Active GI disease (GERD, PUD), CKD, esophageal stricture/varices
It takes —- days (platelet life span) for platelet function to return to normal after a patient stops taking clopidogrel (Plavix).
10
INR values < what increase the risk of stroke sixfold
2.0
Mayonnaise, canola oil, and soybean oil also have high levels of
vitamin K
BP ACC/AHA stages are
normal BP is 120/80
elevated 120-129 and diastolic <80
Stage one is 130 /80-89
Stage 2 is >140 over >90
what BP med is longer acting and more effective than HCTZ
chlorthalidone
pt with osteoporosis and HTN get better benefits from
thiazides
Patients with sulfa allergies should avoid what BP meds
Thiazides and loopsw
what are alternative BP med for patient with sulfa allergy
potassium sparing such as triamterne and amiloride
spironlactone adverse effects is
gynecomastia and hyperkalemia
what are the adverse affects of thiazides
hyperglycemia, elevated cholesterol (hyperlipidemia) Hyperurecimia, hypokalemia
Alpha-blockers are potent vasodilators. Common side effects are
dizziness and hypotension - give at bedtime
tasmulosin (foam)
initial dose may cause a vasovagal response bottoming out BP
what is the first line choice for males wtih both HTN and BPH
Hytrin (terazosin) alpha blocker
fairly common side effects of ACE is
cough
if pt has cough with ACE what do you do
stop ACE and give ARB
ACE 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 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.
ACEIs are first-line therapy for
HF with left ventricular dysfunction (or HFrEF).
Captopril is associated with
agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).
ACEI-induced cough and angioedema are caused by inhibition of the metabolism of
bradykinin and kallikrein system, which are involved in the inflammatory process.
Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients with
HFrEF (can worsen it).
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.
Pedal edema
Dihydropyridine CCBs can cause
peripheral edema, headaches, flushing, and lightheadedness.
Nondihydropyridine CCBs can
worsen cardiac output and cause bradycardia and constipation, which can be problematic for elderly patients.
the main symptoms of CCB poisoning
Hypotension and bradycardia
citalopram (celexa) can prolong what
QT interval
what is a side effect of minocycline
vertigo
what are erythromycins side effects
GI side effects are common (nausea, vomiting, abdominal pain, diarrhea).
what is the most well tolerated macrolide
azithromycin
first-line treatment for gonorrheal infections.
Ceftriaxone (Rocephin) 500 mg IM i
MRSA skin infections (boils, abscesses): Do not use cephalosporins. First-line therapy is
trimethoprim–sulfamethoxazole (Bactrim DS) or clindamycin. Treat for at least 5 to 10 days.
Dicloxacillin is for
for penicillinase-producing staph skin infections (mastitis and impetigo).
Pencillin is given for
Strep throat
Otitis media (first line), rhinosinusitis
Otitis media/rhinosinusitis (first to second line)
Cystitis
Syphilis (first line)
Penicillinase-resistant penicillin; cellulitis (not caused by MRSA), impetigo, erysipelas
what is a serious comp;lication og quinolone therapy
achilles tendon rupture
do not use quinolones in children under 18 and pregnant or breastfeeding adverse effect si
effects on growing cartaligage
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 is treated with
Cipro 750 mg (single dose) or 500 mg twice a day × 3 days.
the first-line drug for treating pseudomonal pneumonia for patients with cystic fibrosis.
Ciprofloxacin has the best activity against Pseudomonas aeruginosa (gram negative)
Patients with a UTI who are on warfarin (Coumadin) should not be given
TMP-SMX (increased risk of bleeding). Monitor INR closely.
Pregnant women (or suspected pregnancy) with a UTI can be treated with
beta-lactams, nitrofurantoin, and fosfomycin.
Capsaicin cream can be used to treat pain in
trigeminal neurlagia and PHN
Maximum number of days that ketorolac (Toradol) can be used is
5 days
The maximum dose for acetaminophen (Tylenol) ranges from
3 - 4 g/d
Discontinue ASA if patient complains of
tinnitus
Maximum number of refills for Schedule III to V drugs is
5 reflills in - 90 pills per refill
echinacea is to
shorten duration of common cold or flu
feverfew or butterbur for
migraine HA
gingko biloba
dementia, memory
isoflavones
estrogen
saw palmetto
BPH
kava kava, valarian root
anxiety, insomnia
ST. johns wort
mild derpresson
turmeric
alzheimers, arthiris
Which of the following is an adverse effect from nondihydropyridine CCBs?
Hyperkalemia
Hypertriglyceridemia
Hyperuricemia
Constipation
Solution: D
Constipation
Constipation affects up to 25% of patients who are on nondihydropyridine CCBs (verapamil, diltiazem). It can be severe in the elderly. It is important that the patient take a soluble fiber daily (e.g., Benefiber), increase fiber intake, walk daily, and ensure adequate fluid intake. Prunes or prune juice daily is also effective. Polyethylene glycol (Miralax) can be mixed with the fiber if the fiber alone is not effective. It takes 12 to 24 hours for Miralax to be effective.
A young adult with myasthenia gravis is diagnosed with pertussis. Which antibiotic is contraindicated in a patient with this condition?
Erythromycin
Doxycycline
Clarithromycin
Azithromycin
Solution: A
Erythromycin
Erythromycin and telithromycin are contraindicated in patients with myasthenia gravis because of potential respiratory collapse. Antibiotics that are safe to prescribe for a patient with myasthenia gravis and pertussis are azithromycin and clarithromycin. Doxycycline is not indicated for the treatment of pertussis.
A possible side effect from the use of nifedipine (Procardia XL) is:
Hyperuricemia and hypoglycemia
Hyperkalemia and angioedema
Edema of the ankles and headache
Dry hacking cough
Solution: C
Edema of the ankles and headache
Common side effects of calcium channel blockers such as nifedipine (Procardia XL) include edema of the ankles, dizziness, headaches, flushing, and weakness. Angiotensin-converting enzyme (ACE) inhibitors tend to have the side effects of angioedema and a dry hacking cough. Diuretics can cause hypokalemia and hyperuricemia.
The nurse practitioner should avoid prescribing all of the following drug classes to patients with sulfa allergies, except:
Thiazides
Loop diuretics
Potassium-sparing diuretics
Protease inhibitors
Solution: C
Potassium-sparing diuretics
Patients with sulfa allergies may be sensitive to thiazides, loop diuretics, and some protease inhibitors (e.g., darunavair, fosamprenavir), which are used in the treatment of HIV. Potassium-sparing diuretics are a safe alternative for patients with severe sulfa allergy
A 3-year-old child with a respiratory virus was given aspirin for an elevated temperature. The child subsequently became lethargic and developed severe vomiting and diarrhea. The nurse practitioner assesses for all of the following findings, except:
Elevated alanine aminotransferase (ALT)
Hyporeflexia
Confusion
Cerebral edema
Solution: B
Hyporeflexia
The patient likely has Reye’s syndrome, which is a rare condition that can develop in children and young adults recuperating from febrile viral infections who ingest aspirin or salicylate medications. The condition can progress very quickly. Stage 1 symptoms are severe vomiting, diarrhea, lethargy, stupor, and elevated ALT and AST. Stage 2 includes personality changes, irritability, aggression, and hyperactive (not hypoactive) reflexes. Stages 3 to 5 present with confusion, delirium, cerebral edema, coma, seizures, and death.
The nurse practitioner will monitor for all of the following side effects in a patient taking hydrochlorothiazide, except:
Hyperglycemia
Hypokalemia
Hypertriglyceridemia
Hypernatremia
Solution: D
Hypernatremia
Side effects of thiazide diuretics such as hydrochlorothiazide are hyperglycemia, hyperuricemia, and hypertriglyceridemia and hypercholesteremia. Patients should also be monitored for hypokalemia, hyponatremia (not hypernatremia), and hypomagnesemia.
A patient visits the primary care office with complaints of nausea, vomiting, confusion, and yellowish-green halos in their vision. The patient’s lab values are potassium of 3.2 mg/dL and calcium of 11.8 mg/dL. Which medication is most likely causing toxicity?
Lithium (carbonate)
Phenytoin (Dilantin)
Digoxin (Lanoxin)
Carbamazepine (Tegretol)
Solution: C
Digoxin (Lanoxin)
The classic symptoms of digoxin toxicity are nausea, vomiting, confusion, and yellowish-green halos in the patient’s vision. Digoxin toxicity can cause hypokalemia and hypercalcemia. Lithium toxicity symptoms are seizures, slurred speech, increased urination, and increased thirst. Phenytoin (Dilantin) toxicity symptoms include nystagmus, ataxia, and confusion. Carbamazepine (Tegretol) toxicity will present as a skin rash and jaundice.
Which medication will the nurse practitioner prescribe to a 28-year-old female newly diagnosed with hypothyroidism?
Levothyroxine T3
Levothyroxine T4
Thyroid-stimulating hormone
Combined levothyroxine T3 and T4
Solution: B
Levothyroxine T4
The current treatment for hypothyroidism is levothyroxine T4. Replacement therapy with levothyroxine T3 alone is not recommended. Much of the conversion of T3 comes from T4. T3 has a very short life span in the body, which would require a patient to take the medication several times a day and may result in imbalanced levels resulting in unpleasant symptoms. Too high of a level can result in injury to the heart and bones. Thyroid-stimulating hormone stimulates the release of T3 and T4 from the thyroid gland, which, in hypothyroidism, is not reacting to producing the hormones in response to stimulation of thyroid-stimulating hormone from the anterior pituitary gland. Combined levothyroxine T3 and T4 can be prescribed, but this does not offer any advantage over prescribing T4 alone.
Which class of antibiotics is first-line treatment for an unvaccinated infant diagnosed with pertussis?
Penicillins
Macrolides
Cephalosporins
Quinolones
Solution: B
Macrolides
The first-line antibiotic treatment for an infant with pertussis are macrolides (azithromycin, erythromycin, or clarithromycin). Penicillins are indicated for strep throat and otitis media. Cephalosporins are appropriate for gram-positive cocci bacteria. Quinolones are effective against gram-negative and atypical bacteria.
The atypical antipsychotic drugs have many adverse effects. Which of the following side effects are most likely to be seen with this drug class?
Orthostatic hypotension and sedation
Malignant hypertension and headache
Skin hyperpigmentation and alopecia
Severe anxiety and increased appetite
Solution: A
Orthostatic hypotension and sedation
Orthostatic hypotension and sedation are common side effects of atypical antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal). It is also a common side effect of the older antipsychotics such as haloperidol (Haldol). Antipsychotics do not cause severe anxiety and hyperphagia (increased appetite). They lower anxiety and cause sedation, sleepiness, anorexia, and hypotension and increase the risk of sudden death in frail elders.
A patient with acute bacterial sinusitis presents with fever, chills, 8/10 facial pain, and mucopurulent nasal drainage. She has an allergy to all penicillins that results in angioedema of the face and throat, with two hospitalizations in the past. Which antibiotic would not be the safest choice to treat this patient with?
a. Doxycycline
b. Moxifloxacin
c. Keflex
d. Azithromycin
C. Even though the cross-reactivity rate is low at 1%, 1st generation cephalosporins contain a side chain and similar structure to penicillin that may create an allergy to a penicillin-allergic patient, especially for those with a history of airway involvement.]
What is the best treatment for a gonorrheal infection in a pregnant patient?
a. Tetracycline
b. Levofloxacin
c. Amoxicillin and clavulanic acid
d. Ceftriaxone
Gonorrhea is best treated with Rocephin 250mg IM and is also safe during pregnancy]
A diabetic patient uses a sliding scale and long-acting insulin to manage her type 1 diabetes. Which insulin would be best for the patient to take for elevated blood glucose between meals?
a. NPH and regular insulin
b. Glargine (Lantus)
c. Lispro (Humalog)
d. NPH
Lispro is a fast-acting insulin that is used on a sliding scale and works from meal to meal. NPH and long-acting Insulin would not be appropriate for a sliding scale.]
