Final Exam: NUR635/ NUR 635 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam Prep| Questions and Verified Answers| 100% Correct – Grand Canyon
Final Exam: NUR635/ NUR 635 (Latest 2023/
2024 Update) Advanced Pharmacology Exam
Prep| Questions and Verified Answers| 100%
Correct – Grand Canyon
Q: When will pt notice improvement after starting an SSRI?
Answer:
4 weeks later
Q: 1st line medication for moderate generalized anxiety
Answer:
Buspar (SNRI)
Q: 1st line med for classic migraines
Answer:
Triptans
Q: 2nd line treatment for classic migraines
Answer:
Prophylactic – propranolol
Q:
Answer:
Q: Why is important that NPs have the authority to prescribe?
Answer:
Increase access to healthcare
Q: What must be done if a drug has a narrow therapeutic index?
Answer:
Frequent serum level monitoring
Q: Why would 10mg percocet or 10mg oxy work better than the other?
Answer:
Differences in pill filler composition
Q: What do medications need in order to be effective:
Answer:
Albumin (binding to)
Q: If a patient has a toxic drug level, but normal albumin, what could be happening?
Answer:
Other drugs competing for albumin
Q: What does “Sig” mean on a prescription?
Answer:
Directions to pharmacist
Q: What items are necessary on a prescription?
Answer:
Drug, dose, route, frequency, quantity, refills
Q: Abbreviations to not use
Answer:
QD
Q: What drug may cause grey teeth?
Answer:
Tetracyclines
Q: Pt reports no improvement in seizures after treatment for a few weeks. What next
Answer:
Assess drug levels for therapeutic index
Q: If patient on phenytoin wants birth control?
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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
1st line medication for moderate generalized anxiety
Buspar (SNRI)
1st line med for classic migraines
Triptans
2nd line treatment for classic migraines
Prophylactic – propranolol
Why is important that NPs have the authority to prescribe?
Increase access to healthcare
What must be done if a drug has a narrow therapeutic index?
Frequent serum level monitoring
Why would 10mg percocet or 10mg oxy work better than the other?
Differences in pill filler composition
What do medications need in order to be effective:
Albumin (binding to)
If a patient has a toxic drug level, but normal albumin, what could be happening?
Other drugs competing for albumin
What does “Sig” mean on a prescription?
Directions to pharmacist
What items are necessary on a prescription?
Drug, dose, route, frequency, quantity, refills
Abbreviations to not use
QD
What drug may cause grey teeth?
Tetracyclines
Pt reports no improvement in seizures after treatment for a few weeks. What next
Assess drug levels for therapeutic index
If patient on phenytoin wants birth control?
Not oral contraceptives! IUD better
Patient on teratogen med wants to get pregnant. When should they stop?
Before getting pregnant, beware first trimester
Pregnant pt has been taking daily aspirin. Concern for what?
Premature close of PFO
Pain treatment for shingles?
Lidocaine after lesions heal
How does reglan help with GERD?
Increases esophageal tone
Who should not take calcium carbonate antacids?
Pt with kidney stones
Pt on minocycline with HA. Pt has what?
Pseudotumor Cerebri
Why do we rotate off phentermine?
Pt will develop tolerance
Education on flagyl?
Avoid alcohol – severe reaction
What is minocycline?
Tetracycline for acne
Minocycline can be given safely to?
Adolescents (no pregnancy or liver fx)
New dx of GERD. First therapy? How often?
H2 blocker – BID
Paxil side effects to educate?
Sexual dysfunction, can resolve on its own
What medication for pregnant UTI?
Amoxicillin
Theophylline, NV/HA after starting. What do?
See if it resolves in a couple of days
ICS and beta agonist. Which first?
Beta first, then ICS
SSRI Paxil, how long til it works?
2-6 weeks
Pt high risk for osteoporosis. Education?
Vit D/Calcium + weight bearing exercise
Pt started on antibiotics. Bloody diarrhea. Pt has?
C. diff
Asthma patient, education on worsening symptoms?
Call provider, use rescue inhaler more
Patient with panic disorder?
valium
Adverse effects of singular?
Aggression, anxiety, suicidal ideation
Depression with anxiety, what med?
Lexapro
What to check before starting pt on acyclovir?
Renal function
How long til improvement on Celexa?
1-2 weeks
Step down approach for GERD, what do they start on?
PPIs
Known G63D deficiency, what antibiotic can you not prescribe?
Sulfas
Chantix – pt education?
Psych side effects, dreams, suicide ideation
Why should older patients take 2nd gen antihistamines rather than 1st?
CNS effects & urinary retention
Genital herpes outbreak, what med?
Acyclovir
UTI, med, how long?
Bactrim, 3 days
MRSA skin infection. What med?
Bactrim
Patient has pheochromocytoma. What med to avoid?
Albuterol – hypertensive crisis
How to taper medication?
Decrease by 50% every 3-4 days
What is methylnaltrexone?
Treats opioid associated constipation
SSRI, wants something for weight loss. Why not phentermine?
Serotonin syndrome
Sprained ankle with soft tissue swelling, what med?
NSAID
Neuropathic pain, med?
Gabapentin
Adverse drug reaction of haldol?
Extrapyramidal symptoms.
When to take dimenhydrinate?
15 min prior to trip
Antifungal therapy long term puts you at risk for?
liver toxicity
Giving pt eye drops, education?
don’t wear contacts, wash hands in between handling
Who should avoid ophthalmic beta blockers?
Pts on beta blockers
What bronchodilator is safe on beta blocker?
Ipratropium
How to antacids work?
increases our pH
Lithium education?
sodium can influence your lithium levels. So intake should be consistent.
PPIs long term, monitor for?
Osteoporosis, check calcium. Anemia.
Antibiotic education?
Finish course of therapy. Drink lots of water.
How quickly should you see improvement in pneumonia with antibiotics?
48-72 hours
Long term lactulose for constipation, what do you monitor?
Potassium and chloride
Patient started on ICS. Education?
rinse mouth after every use
Patient with PUD has Hpylori. 1st treatment?
PPI + amoxicillin + clarithromycin
What medication can aggravate GERD by affecting esophageal tone?
Estrogen
Why do long acting beta agonists have blackbox warning?
Can be accidently taken instead of albuterol for acute asthma attack
Allergy to PCN. What else can they not receive? Why?
Cephalosporins, both vulnerable to beta lactamase producing organisms
Gonorrhea in a 20yo female with oral contraceptives. Education?
Need back up until next menses
How to treat eye gonorrhea?
Ceftriaxone, eye drops
Who is most at risk for a fatal asthma attack?
Previous hx of intubation
What can help with peripheral neuropathy?
B6
When can you prescribe tamiflu?
can only give in first 24 hrs of symptoms
Treating depression, pt feels only partial improvement. What next?
change drug or increase dose
New onset of mild-mod anxiety, first treatment?
buspar
Levaquin blackbox warning
tendon rupture
Decongestant to older patients, what route?
Nasal, no systemic side effects
Child with acute otitis media, how to treat pain?
Lidocaine eardrops
Azithromycin – how to dose?
Titrating z pack
Otitis externa, how to treat?
Cipro and hydrocortisone drop
Contraindications to antibiotic ear drops?
Ruptured tympanic membrane
Pt with acute otitis media with conjunctivitis?
High dose amoxicillin
Why do we worry about st johns wort?
Interacts with many medications, accelerates metabolism of drugs
Why does topamax help you lose weight?
Gives sensation of fullness
Severe alcoholic with bad withdrawal?
Thiamine and banana bag.
Pt malnourished, infected mouth, sores. Suspect?
Scurvy
Pt has flushing, what could they be taking?
May be taking niacin
How to treat elevated ammonia?
Lactulose
Biggest side effect of hydrocodone – constipation, how to treat?
Senna, docusate, miralax
Step 1 management of asthma?
short acting alpha 2
Guaifenesin – how does it work?
thins secretions, easier to cough up
How to treat afrin overuse?
Nasal steroids while weaning
Alendronate education?
30 min before meal, lots of water
Increase pain with paget’s disease, what treatment?
Calcitonin salmon
What is paget’s disease?
Abnormal bone reabsorption
More than 3 gout flare ups in past year?
Allopurinol
What is probenecid used for?
Chronic gout
New diagnosis of rheumatoid arthritis, what med?
Methotrexate
Which vaccines don’t we need at age 11?
Hep B, PCV23
Education on flexeril (cyclobenzaprine)?
CNS depression, urinary retention, blurred vision
Pilocarpine – what does it do?
Drains fluid from the eye to treat glaucoma
Why do we no longer prescribe demerol?
Many side effects
Patient on hydrocodone, not as effective. Why?
Developed a tolerance (increase dose)
How to dose pancreatic enzymes?
Units of lipase
Who needs pancreatic enzymes?
Cystic fibrosis, gastric bypass
How to titrate pancreatic enzymes?
Based off poop color (steatorrhea)
Soft tissue only mrsa?
sulfamethoxazole/trimethoprim (Bactrim)
More invasive MRSA, med?
cephalexin (Keflex)
Why do we not treat onychomycosis?
Liver toxic
Community acquired with comorbidities – outpatient?
Rocephin + azithromycin
How to treat PUD peptic ulcer disease?
PPI + clarithromycin + amoxicillin
Mild intermittent asthma
SABA
1st step of asthma
albuterol
2nd step of asthma
give SABAs
How do you know you need to bump up asthma tier plan?
Rescue inhaler more than 2x week or more than 1x day.
Why should a pt never run out of paxil?
Short half life. Will withdraw really quick
Pt with new onset depression. What to check first?
Check thyroid labs
