Midterm Exam: NUR635/ NUR 635 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam Review| Questions and Verified Answers| 100% Correct – Grand Canyon
Midterm Exam: NUR635/ NUR 635 (Latest
2023/ 2024 Update) Advanced Pharmacology
Exam Review| Questions and Verified
Answers| 100% Correct – Grand Canyon
Q: What can be caused if pt started on heparin?
Answer:
day4, ordering blood work to check platelet count to observe for THROMBOCYTOPENIA
Q: coumadin and childbearing aged females
Answer:
Interactions with oral contraceptives- must have a back up method during time you’re taking
coumadin
Q: Pregnancy considerations and coumadin
Answer:
Need to monitor anti-Xa levels
Q: biggest food group interaction with coumadin
Answer:
Grapefruit, green leafy veggies. Why? high in vitamin K which counteracts warfarin
Q: Short duration: rapid acting insulin indication, MOA, usage
Answer:
Given w/meals
Provide bs control between meals at night
Can use in conjunction w/intermediate or long-acting agent
lispro, aspart, gluulocene
Q: Short duration: short acting insulin indication, MOA, usage
Answer:
Before meals to control postprandial hyperglycemia
Infused SQ via pump
humulin/regular
Q: intermediate(humalin/novalin) duration insulin indication, MOA, usage
Answer:
BS control between meals and during the night
Only one suitable for mixing w/short actings
basal coverage
Q: Long duration: Insulin glargine U100
Answer:
up to 24hrs, once daily subq dosing, basal coverage for DM1 or Dm2
Q: Neostigmine is a medication uesd to tx what disease/disorder?
Answer:
Myastenia Gravis: AI disorder, antibodies destroy communication btw nerves and muscles. S/S
weak skeletal muscles, voluntary muscles, dysphagia, ptosis
Q: Myasthenia gravis is an AI disorder that may cause what s/s?
Answer:
difficulty swallowing
Q: Medication must cross _ to affect CNS
Answer:
BBB
Q: Goal in Parkinson’s tx is to restore ____ in brain
Answer:
dopamine
Q: MCSE of dopaminergics
Answer:
sleep attacks, hallucinations, confusion
Q: Med appropriate to treat acute psychosis?
Answer:
Haloperidol
Q: ASE of first-generation antipsychotic(FGA) medications such as haloperidol,
chlorpromazine: diff speaking, chewing
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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
Long duration: Insulin glargine U100
up to 24hrs, once daily subq dosing, basal coverage for DM1 or Dm2
Neostigmine is a medication uesd to tx what disease/disorder?
Myastenia Gravis: AI disorder, antibodies destroy communication btw nerves and muscles. S/S weak skeletal muscles, voluntary muscles, dysphagia, ptosis
Myasthenia gravis is an AI disorder that may cause what s/s?
difficulty swallowing
Medication must cross _ to affect CNS
BBB
Goal in Parkinson’s tx is to restore ____ in brain
dopamine
MCSE of dopaminergics
sleep attacks, hallucinations, confusion
Med appropriate to treat acute psychosis?
Haloperidol
ASE of first-generation antipsychotic(FGA) medications such as haloperidol, chlorpromazine: diff speaking, chewing
tardive dyskinesia
Med to help manage panic attacks?
SSRI
Cholinesterase inhibitors are used in tx of what conditon?
Alzheimer’s disease. MOA block normal breakdown of acetylocholine which increases their levels and duration of action in the CNS and PNS (neuromuscular junction). Also used in tx of myasthenia gravis Ex: neostigmine, donepezil, galantamine, rivastigmine
What are some diseases/disorders/conditions are anticonvulsants used to treat other than seizure disorders?
migraine HA prevention, bipolar DO, epilepsy Examples: carbamazepine(Tegretol), gabapentin(Neurontin), phenobarbital, topiramate(Topamax)
Anti-seizure med used for prophylactic tx of migraines
topiramate
Anti-seizure med that is also an anti-arrhythmic
phenytoin(Dilantin)
Anti-seizure med w/black box warning for blood dyscrasias and serious derm rxns
carbamazepine(Tegretol)
First-line agent for early onset migraine
NSAIDs
Hallucinations may occur if __ is stopped abruptly
baclofen
atomoxetine(Straterra), clonidine, and guanfacine are used in tx of which DO?
ADHD
initial intervention for infrequent migraine HA
HA diary
Meds that may cause QT prolongation
methadone, tricyclic antidepressants, amiodarone
CI for a triptan includes
htn, CAD, MAOI use. Triptans used to ease migraine symptoms by calming overactive nerves in the brain and vasoconstriction of blood vessels in the brain
What to give for hives and wheezing r/t pb?
epinephrine IM
Beta blockers have been used to treat _, , ___
post MI, HTN, HF
Drug route for 100% bioavailability
IV
Chronic renal failure will affect _ element of pharmacokinetics
excretion
Adrenergic antagonists or alpha blockers cause ________
vasodilation
in addition to lowering BP, alpha blockers are used in tx of __
BPH
symptoms of BPH
urinary frequency and urgency, nocturia, hesitancy and difficulty continuing to urinate, reduced force and size of urinary stream (“weak” stream), sensation of incomplete bladder emptying, straining to begin urination, post-void dribbling or leaking, hematuria, enlarged prostate
Common side effect of ACE inhibitors
dry cough
Angina is a pain caused by _____
cardiac ischemia
All pts with angina should receive what drug for prophylaxis of a myocardial infarction?
aspirin- antiplatelet
lifestyle modifications to reduce cardiac risk include
Wt loss (at least 10lbs), stop smoking, daily exercise
Pt w/ heart failure, angina w/walking and slight limitation of activity is what class?
Class II
pt is taking hydrochlorothiazide(HCTZ) for HTN. What lab is most impt to monitor?
K, for hypokalemia.
Hypokalemia can result in abnormal heart rhythms, cramp and twitch muscles.
HCTZ, thiazide diuretic, removes excess salt and water
cardiac remodeling in HF
Worsens HF. The wall of the left ventricle thickens and enlarges in an attempt to compensate for the increased workload.
class of medication in pts post MI to prevent cardiac remodeling
ACE inhibitors. ACE inhibitors are known to increase tissue bradykinin accumulation. Bradykinin has antigrowth effects and reduces vasomotor tone.
When tx hyperlipidemia, calculation __ risk will help to determine tx.
ASCVD risk, Atherosclerotic cardiovascular disease
Class of medication contraindicated in pts w/liver failure
HMG-CoA inhibitors(Statins). Because all statins are hepatically cleared and can cause elevations in liver biochemistries, there is a concern that patients with underlying liver disease may be at increased risk for hepatotoxicity.
Which anticoagulant has the quickest onset of action?
Heparin
Pts receiving heparin are at risk for what adverse rxn?
thrombocytpenia. Condition in which you have a low blood platelet count, not enough platelets, increased risk of bleeding
Why would heparin and warfarin be given at the same time?
warfarin has a delayed effect
Risk factors that increase a pts ability to bleed
herbal supplements, aspirin use, TPA
Factor Xa levels may be monitored in pts on this med
low molecular wt heparin, LMWH has better bioavail and longer half-life than heparin(ex: enoxaparin)
Meds to be avoided in pregnancy
statins, warfarin, ACE inhibitors
Post hip replacement, med used to prevent DVT
enoxaparin
Pt started on warfarin for a fib should be taught that________
INR should be between 2-3
Epoetin alfa (erythropoietin)
biologic response modifier
can treat anemia to increase Hgb concentration, carries risk of tumor dev, can cause HTN, increases RBC production
pernicious anemia is due to deficiency in _
B12
Lab monitoring for iron def anemia include
reticulocyte count in 1 wk, total iron binding capacity (TIBC) in 4 wks, Hgb/Hct in 4 wks
Which class of antidiabetic med used to tx CKD stage 4-5
Sulfonylureas: Sulphonylureas are insulin secretagogues, which means they work by causing the body to secrete insulin.
DPP-4 inhibitors: help keep blood glucose from going too high by increasing the insulin produced by pancreas, especially right after a meal and decreasing glucagon, a hormone that releases glucose from the liver.
SLGT-2 inhibitors: also known as gliflozins, prevent the reabsorption of glucose from blood that’s filtered through kidneys, therefore facilitating glucose excretion in the urine.
Pregnancy considerations for the pt taking diabetic meds
she will be switched to insulin during pregnancy
MOA of metformin (Glucophage)
Increases action in peripheral tissues to increase insulin sensitivity, decreases hepatic glucose production, reduces glucose absorption in the gut
When starting basal insulin, which class of med should be reduced or dc?
sulfonylurea bc these cause the body to secrete insulin
Alcohol can mask the s/s of hypoglycemia. Symptoms of hypoglycemia:
sweating, fatigue, tired, dizzy, hungry, shaky or trembling, tachycardia, irritable, anxious, moody, tingly lips
diabetics that develop HTN should be started on what class of med?
ACE inhibitor
when to take levothyroxine (synthroid)
First thing in the morning, 30 mins prior to eating
Lab level that indicates effectiveness of levothyroxine
decrease in TSH
Form of estrogen w/ least SE
transdermal
Post menopausal screening questions before HRT
Smoker?
Hysterctomy?
Hx DVT/PE?
Concern for male pt with 7lb wt gain requesting an early refill on testosterone.
Testosterone abuse
Epotetin Alfa/ EPOGEN/PROCRIT
o Erythopoesis stimulating agent
o Used in anemia especially in presence of CKD or chemo-related
o May be used preoperatively for transfusion reduction- start 10 days before sx and cont for 4 days post
o Check Hgb weekly w/tx start until stable
o Black Box:
§ Increased CV events with adm to Hgb>11
§ Increased mortality CAN CAUSE TUMORS and tumor progression in CA pts, dc once chemo completed
§ Increased thromboembolic events in sx pts- use DVT prophylaxis
Vitamin B12 Deficiency
o Causes
§ Impaired absorption
§ Lack of intrinsic factor (PERNICIOUS ANEMIA)
o Consequences: megaloblastic anemia, neurological damage, death
o DX: megaloblastic anemia, low plasma B12
o TX: parental cyanocobalamin
Ferrous Sulfate
o TX of choice for IDA (iron def. anemia)
o Preferred drug for preventing def when iron needs unmet by diet
o ASE: GI disturbance- nausea, heartburn, constipation, diarrhea. May cause dark green/black stools.
o Avoid in pts w/peptic ulcers or ulcerative colitis
o Toxicity: LEADING CAUSE OF POISONING FATALITIES IN CHILDREN, death rare in adults
o Antacids reduce absorption
o ASCORBIC ACID INCREASES ABSORPTION
o RETICULOCYTES WILL INCREASE IN 4-7 DAYS, Hgb/Hct w/in 1 wk, Hgb should rise 2g/dl after 1 mos
Aspirin/ASA
o Cyclooxygenase inhibitor (inhibits Cox-1 and Cox-2)
o Chemical family: salicylates- acetic salicylic acid
o Inhibition of COX-2:
§ reduction of pain, inflammation, fever
§ harmful SE: renal impairment, prevention of MI, stroke (suppresses vasodilation)
o Inhibition of COX-1:
§ Protection against MI/stroke secondary to reduced platelet aggregation
§ Harmful SE: gastric erosion/ulcers, bleeding tendencies, renal impairment
o Decreases risk of colorectal CA (r/t effects of COS-2 inhibition which slows tumor growth)
o Saliclyism: supratherapeutic levels- tinnitus, sweating, HA, dizziness
o Reye syndrome: avoid use under 18yrs
often prescribed w/levodopa-carbidopa in tx of Parkinson’s Disease
Bromocriptine
taking too much of these can make you “blind as a bat” or “mad as a hatter”
anticholinergics & antimuscarinics
absorption, distribution, metabolism, excretion
pharmacokinetic processes
drug used to relieve myasthenic crisis
Neostigmine/pyridostigmine (cholinergic or ace inhibitor)
drug w/very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently
Lithium
drug class that carries an increased risk of suicidality in children, adolescents and young adults
SSRI/SNRIs
antidote for organophosphate poisoning
Atropine
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 tx of Alzheimer’s disease
Cholinesterase inhibitors
drug has led to the death of children in ultrarapid metabolizers as 10% is converted into morphine
Codeine
leading cause of liver failure in U.S.
Hepatotoxic drugs
autoimmune disease that attacks the nicotinic receptors in skeletal muscle
Myasthenia Gravis
opioid agonist that works quickly to reverse CNS and respiratory depression
Naloxone/Narcan
how drug affects the body
Pharmacodynamics
term for amt of drug that reaches systemic circulation. Often affected by route of admin.
Bioavailability
symptoms for this syndrome include confusion, irritability, tachcardia, htn, diaphoresis, and is caused by having too much of this “happy” substance
Serotonin
dopamine agonist often used in tx of Parkinson’s disease that is least likely to cause sleep attacks
Pramipexole
clonidine is often prescribed to children to tx this disorder
ADHD
Drug most effective in ETOH withdrawal
lorazepam/ ATIVAN
Drug used for anaphylactic rxn or cardiac arrest
epinephrine
1st line drug for migraine prevention
beta blockers (propanolol)
parasympatholytic used for unstable bradycardia
atropine
drug class used to tx ADHD
stimulants
drugs that have no medical use and high potential for abuse
schedule I controlled substances/ illicit
this drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly
baclofen
this muscle relaxant is also a schedule IV controlled substance
carisoprodol/SOMA
1st line abortive drug for mild to moderate HA
NSAIDs
1st line abortive drug for mod to severe migraine HA
sumatriptain/IMITREX
used in tx of non hypovolemic hypotension
norepinephrine or phenylephrine
drug used for acute mgmt. of seizure
lorazepam
used in tx of beta blocker overdose
glucagon (increases heart rate and myocardial contractility)
often used for tx of opiod use disorder. May cause QT prolongation
methadone
this opioid analgesic is used for tx of postop shivering or rigors
meperidine/ DEMEROL
antiseizure medication that carries black box warning for severe skin rxns such as Steven-Johnson syndrome
carbamazepine.
Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days.
drug class used to tx extrapyramidal symptoms
anticholinergics
cause of menstrual associated migraine
drop in estrogen level
chronic use may cause amotivational syndrome of hyperemesis syndrome
marijuana or THC
a deadly bacterial toxin used in prevention of chronic migraine HA
botox/botulinum toxin
Pt taking epoetin alpha. What do I need to monitor?
BP, epoetin alpha can cause HTN because it can produce too many RBCs
What three meds to we prescribe to pts w/angina?
statin, ASA, nitro
If I want to self-donate blood, what would I take. 2 drugs:
Epogen and iron
If I prescribe iron, what lab to I order 1 week out?
Reticulocyte count. Rationale: reticulocytes are the immature (teen) red blood cells. A high count confirms production is being increased.
TIBC- 4 wk
Ferratin-4 wk
Hgb/hct-4wk
pt education for iron replacement
Empty stomach
with glass of OJ
when taking B12, what do we need to monitor for in first couple of days?
Hypokalemia can happen first two days as a result of increased rbc requirements during hematopoiesis
how long for NPH onset?
60-90 mins
biggest SE for tx of DM?
hypoglycemia: cold and clammy needs some candy
alcohol plus beta blockers risk?
ETOH masks s/s hypoglycemia in DM pts
switching pt from NPH(intermediate) to glargine(long-acting), what do I have to do dosing glargine?
Decrease glargine by 20% to avoid hypoglycemia
Considerations for prescribing metformin
Contrast studies= hydration status, A1C (is it working?), renal function baseline,
Gliptins (DPP-4 Inhibitors)
indirectly increase insulin production through incretin system
GLP-1 agonists MOA
-directly bind to pancreatic cells to stim insulin production
-reduce glucose output, lowering blood sugar
-slows glucose absorption into bloodstream by reducing speed of stomach emptying, increasing satiety
Angina w/o s/s, staging?
Stage I
Stage II- angina w/min exertion
Stage III- angina even without much exertion/ activity
Stage V- even at 4, ready for a CABG
Two reasons we see pts go into HF
cardiac remodeling r/t myocardial ischemia or MI
CI with flagyll
ETOH, cannot drink on flagyll
With any prescribed hepatotoxic meds, what are needed baseline labs?
AST,ALT
Most dangerous time for pregnant person to consume a teratogen
1st trimester, neural tube defects
BFing pt. When should she take a med with questionable safety?
Right after feeding baby.
What does baclofen treat?
spasticity, muscle spasms, MS, spinal cord injuries, cerebral palsy
Rivastigmine (Exelon)
alzheimer’s tx
daily transdermal patch
Oxycodone tolerance
If pt dev. tolerance, w go to something stronger, long-acting.
methadone monitoring parameters
EKG once a year bc QT prolongation risk
If pt is on MAOI and I want them started on an SNRI, what must we do
Need to stop for 2 weeks before starting the other
pre surgical considerations for pt’s taking oral contraceptives
Progesterone only reduces chances of clots
