PACKAGE DEAL: NUR 635 Midterm & Final Exams (100% Correct Answers)
NUR 635 Midterm Exam (GRADED A) Questions and
Answers (100% Correct Elaborations)
Often prescribed with levodopa/carbidopa in the treatment of Parkinson’s
Disease
Bromocriptine
What medication may cause serious or possibly life-threatening sleep behaviors,
such as sleep driving?
Ambien
Taking too much of this type of drug can make you “blind as a bat” or “mad as a
hatter”
Anticholinergics, antimuscarinics
Absorption, Distribution, Metabolism, excretion
Pharmacokinetics
Drugs used to relieve a myasthenic crisis
Neostigmine, pyridostigmine
This drug has a very narrow therapeutic index and high risk for toxicity, therefore
levels should be monitored frequently
Lithium
The drug class that carries an increased risk of suicidality in children, adolescents,
and young adults
SSRIs/SNRIs
The antidote for organophosphate poisoning
Atropine
This drug class double the rate of mortality in older adults with dementia
Antipsychotics
In infants, this is not fully developed and therefore infants are more sensitive to
CNS drugs
Blood Brain Barrier
Time of development that fetus is at highest risk of teratogenicity from a drug
First trimester
Do not stop this class of drug abruptly due to an increased risk of cardiovascular
events
Beta-blockers
Agents that indirectly block the breakdown of acetylcholine and are often used in
treatment of Alzheimer’s Disease
Cholinesterase inhibitors
Adverse drug reaction that causes difficulty speaking and chewing and worm-like
movements of the tongue
Tardive Dyskinesia
Receptor found in the lungs that causes bronchodilation when activated
Beta 2 Receptors
This drug has led to the death of children in ultrarapid metabolizers as 10% of the
drug is converted to morphine
Codeine
NUR 635 Advanced Pharmacology Midterm Review
(Guaranteed Pass)
Pt on heparin in hospital setting. Why start coumadin 2 days before dc?
Because coumadin needs a couple days before it starts working.
Angina: bc pts dev tolerance to long-acting nitroglycerine w/i 1 day. How to
prevent?
Pts must have 8hrs with no nitroglycerine every days. Hint: At night, remove nitro
patch bc no risk of exertional angina
Underlying cause of angina
coronary disease, athlerosclerosis
Why do we give aspirin in pts w/atherosclerosis?
Aspirin is an antiplatelet.. Prevents the existing plaques from getting bigger.
Prevents plaque rupture. Cardio protective, prevents stroke, MI, CVA
What is prescribed for angina pts w/DM?
ACE inhibitors to protect the kidneys and nerves
SE of high doses of aspirin?
Tinnitus: ringing ears
Pt education regarding Plavix(clopidogrel bisulfate)?
Anti-platelet med. S/sx bleeding: blood in stool or vomit, excessive bruising, abd
pain uterine bld, back pain, petichae. Interactions with EVERYTHING: OTC,
herbals, supplements
Pts on coumadin? What are we watching for?
INR to check therapeutic levels. Half life is long. Check 12hrs after taking.
What can be caused if pt started on heparin?
day4, ordering blood work to check platelet count to observe for
THROMBOCYTOPENIA
coumadin and childbearing aged females
Interactions with oral contraceptives- must have a back up method during time
you’re taking coumadin
Pregnancy considerations and coumadin
Need to monitor anti-Xa levels
biggest food group interaction with coumadin
Grapefruit, green leafy veggies. Why? high in vitamin K which counteracts
warfarin
Short duration: rapid acting insulin indication, MOA, usage
Given w/meals
Provide bs control between meals at night
Can use in conjunction w/intermediate or long-acting agent
lispro, aspart, gluulocene
Short duration: short acting insulin indication, MOA, usage
Before meals to control postprandial hyperglycemia
Infused SQ via pump
humulin/regular
intermediate(humalin/novalin) duration insulin indication, MOA, usage
BS control between meals and during the night
Only one suitable for mixing w/short actings
basal coverage
NUR 635 Pharm Final Exam Questions and Answers
(Already GRADED A)
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. a guideline.
B. cost.
C. availability.
D. patient hepatic and renal function.
A. a guideline
Drugs that alter synaptic transmission are much more selective than those that
alter axonal conduction, why is this?
a drug that affects the axonal conduction – non-selective effect.
Drugs that alter synaptic transmission – very selective because of the differences
in synapses and their specific neurotransmitters
What is phenytoin used for?
Seizures
What should you monitor for with phenytoin?
Delayed hypersensitivity – even 1 month later
What is carbamazepine used for?
Seizures
What may cause carbamazepine levels to drop despite no other change? What to
do?
Autometabolization of drug. Increase dose.
What is the black box warning for carbamazepine?
Steven-Johnson Syndrome & TENS
Monitoring for carbamazepine, and how often?
CBC, 3-4 times a year
What population is most at risk for Steven-Johnson syndrome & TENS when
taking carbamazepine?
Asian patients
Main class of medication for depression?
Selective serotonin reuptake inhibitors (SSRIs)
What to watch for with SSRIs?
Other medications that can cause serotonin syndrome
What is lamictal used for?
Seizures
Patient on lamictal has fever, rash, swollen lymph nodes. What are we concerned
for?
Hypersensitivity in lamictal can lead to MODS
Patient on lamictal wants birth control. What do we need to change?
Increase lamictal dose.
When will pt notice improvement after starting an SSRI?
4 weeks later
NUR 635 Advanced Pharmacology Mid-Term Exam
(Correctly answered with Rationales)
The process by which the body break down and coverts a medication into active
subtance is know as
metabolism
The term NOT associated with the pharmacokinetics of a drug is
Pharmacodynamics
Rationale: Pharmacokinetics can be simply described as the study of ‘what the
body does to the drugs’ and includes: the rate and extend to which drugs are
absorbed and distributed to body tissue; the rate and pathways by which drugs
are eliminated from the body by metabolism and excretion; and the relationship
between time and plasma drug concentration. It includes the processes of
absorption, distribution, metabolism, and excretion. Pharmacodynamics is the
effect that a drug has on the body. Terms associated with pharmacodynamics
include receptors (i.e. affinity), drug potency (i.e. amount of drug required to
produce a therapeutic response), and drug response cure (i.e. effective dose,
toxic dose, therapeutic index).
The elimination phase of pharmacokinetics is the time it takes for the plasma
concentration of a drug to decrease by
50%
Rationale: The elimination phase or elimination half-life is the time required for a
drug to reach half (50%) of its state in the serum.
The pharmacokinetics of a drug may be affected by
Compliance by the patient.
Rationale: Factors that affect the pharmacokinetics (what the body does to the
drug) of a drug include: compliance by the patient; dosing and medication error;
absorption; tissue and body fluid; mass and volume; drug interaction; elimination
and drug metabolism. Pharmacokinetics will be variable if the drug does not reach
the body or doesn’t stay in the body long enough. Pharmacodynamics (what the
drug does to the body) is affected by drug receptors, genetic factors, drug
interaction, and tolerance.
In the pharmacokinetics of a drug, the rate of metabolism:
varies widely among patients.
Rationale: Metabolism is the process by which drugs are chemically changed from
a lipid-soluble from suitable for absorption and distribution to a more watersoluble form that is suitable for excretion. The rate of drug metabolism varies
widely among patients, influenced by genetic and environmental factors. This is
the major reason for differences in the plasma concentration of some drugs after
a standard dose, leading to wide variation in drug response.
The type of study that defines the mayor metabolites concentrations in serum
and other body compartment is:
Pharmacokinetics Studies
NUR 635 Final Exam Review Questions and Answers
(GRADED A) Grand Canyon University
First line tmt for a previously healthy person who develops CAP?
Azirthomycin
If you see SSRI (selective serotonin reuptake inhibitor) and St. John’s wort
together?
Serotonin syndrome
Hypersensitivity with Phenytoin?
3-8 weeks after treatment can occur (overly sensitive to this medication and have
adverse reactions)
This would look like a characteristic rash, fever, leukocytosis
Carbamazepine can auto-metabolize?
YES.
This can auto-metabolize so you will end up with lower levels
If a patient has been in range, and nothing has changed, it is due to this mediation
auto-metabolizing so the levels are lower despite them taking medication with
compliance
INCREASE the dose
Carbamazepine black box?
Steven Johnsons Syndrome
Carbamazepine monitoring
Monitor a CBC, every 3-4 months to watch for agranulocytosis
Gabapentin
This affects GABA, and is used to treat neurontin pain
When you drink alcohol there are more GABA production
A patient is on gabapentin and having strange thoughts, what do you need to ask
them?
You need to ask about suicidal ideation
Worried about a patient having a reaction to lamotrigine?
This has a high risk for hypersensitivity
How do Lamotrigine and oral contraceptives interact?
Reduces the lamotrigine levels thus you end up increasing the lamotrigine dose
TCA antidepressants, what comorbidities should you avoid when prescribing
them?
Cardiac disease
How long are we going to tell patients that they are going to see a response with
an SSRI?
2-6 weeks
If you have a schizophrenic patient and you give them haldol what do you assess
for?
Extrapyramidal symptoms (EPS)
Do not need peak and trough. Should have continuous EKG but EKG will not help
monitor for EPS.
Will the beta agonist overpower the digoxin?
A beta agonist anything with dysrhythmia will speed up the HR
Digoxin is dysrhythmic and slows down the HR.
Do we give a beta 2 agonist (albuterol) with those with a pheochromocytoma
(puts you at risk for HTN)?
NO because it will cause a Hypertensive crisis on the adrenal glands
You have moderate persistent asthma, which medication has a black box warning
against using it as a singular agent to treat this?
You do not treat asthma patients or should cautiously as there is an increased risk
with asthma patients when using LABA (salmeterol and formoterol)
Black box warning is that reports for severe asthma exacerbations occur thus
causing death
Spiriva
inhales anticholinergics used for the tmt of COPD
If you prescribe someone with beclomethasone how should they use it?