NR566 / NR 566 Midterm Exam (Latest 2024 / 2025): Advanced Pharmacology for Care of the Family – Chamberlain
NR-566 Advanced Pharmacology for
Care of the Family
Midterm Exam
What pathogen is highly associated with CAP in general population?
Correct Answer:
streptococcus pneumoniae
Other common pathogens with CAP
Correct Answer:
atypical bacteria (mycoplasma pneumonia)
viruses (influenza, respiratory syncytial virus)
First line treatment CAP in previous healthy adults
Correct Answer:
Amoxicillin, doxycycline, macrolides (DAM)
Treatment of CAP in pregnancy
Correct Answer:
amoxicillin, cephalosporins, erythromycin (ACE)
Treatment for mycoplasma pneumonia in the pediatric patient
Correct Answer:
Macrolides (erythromycin, clarithromycin, azithromycin)
treatment of chlamydial pneumonia in infant
Correct Answer:
Erythromycin base/ethylsuccinate
Broad spectrum antibiotics – when to use?
Correct Answer:
empiric therapy
When you don’t know which bacteria it is
more likely to facilitate emergence of drug-resistant organisms and
superinfections
prescribe these before culture results back
suspects patient has UTI
Narrow spectrum antibiotics – when to use?
Correct Answer:
When the pathogen is known
Preferred
What are empiric antibiotics?
Correct Answer:
Broad Spectrum antibiotics that are given BEFORE the results are in for
certain circumstances.
Also can be prescribed when the NP believes it is a certain disease.
A) Prescription for an antibiotic for severe infection based on knowledge
B) Prescription of an antibiotic for severe infection based on clinical
evaluation
C) Prescription of antibiotic for severe infection based on most likely
causative agent
When to prescribe empiric antibiotics?
Correct Answer:
E for Emergency
E for enticpation
Embulatory patients
Pt has severe infxn, initiate treatment before test results available
How to treat C Diff
Correct Answer:
Stop taking the abx that caused it
flagyl and vancomycin
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What pathogen is highly associated with CAP in general population?
streptococcus pneumoniae
Other common pathogens with CAP
atypical bacteria (mycoplasma pneumonia)
viruses (influenza, respiratory syncytial virus)
First line treatment CAP in previous healthy adults
Amoxicillin, doxycycline, macrolides (DAM)
Treatment of CAP in pregnancy
amoxicillin, cephalosporins, erythromycin (ACE)
Treatment for mycoplasma pneumonia in the pediatric patient
Macrolides (erythromycin, clarithromycin, azithromycin)
treatment of chlamydial pneumonia in infant
Erythromycin base/ethylsuccinate
Broad spectrum antibiotics – when to use?
empiric therapy
When you don’t know which bacteria it is
more likely to facilitate emergence of drug-resistant organisms and superinfections
prescribe these before culture results back
suspects patient has UTI
Narrow spectrum antibiotics – when to use?
When the pathogen is known
Preferred
What are empiric antibiotics?
Broad Spectrum antibiotics that are given BEFORE the results are in for certain circumstances.
Also can be prescribed when the NP believes it is a certain disease.
A)Prescription for an antibiotic for severe infection based on knowledge
B)Prescription of an antibiotic for severe infection based on clinical evaluation
C)Prescription of antibiotic for severe infection based on most likely causative agent
When to prescribe empiric antibiotics?
E for Emergency
E for enticpation
Embulatory patients
Pt has severe infxn, initiate treatment before test results available
How to treat C Diff
Stop taking the abx that caused it
flagyl and vancomycin
Drug class known for all drugs in class to promote development of C diff
cephalosporins (especially second or third generations)
Penicillin’s have cross-sensitivity with which drug class?
cephalosporins
Can you take penicillin’s if pregnant?
Yes
Can you prescribe cephalosporins if pregnant?
yes
Patient education needed for cephalosporins
Can promote C diff, instruct patients to report increase in stool frequency
Can you prescribe tetracyclines in pregnant patients
No – can cause tooth staining
Patient education for tetracyclines
Photosensitivity. Advise patients to avoid prolonged exposure to sunlight, to wear protective clothing, and to apply sunscreen to exposed skin/avoid tanning beds.
Instruct patients not to take this medication together with calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids.
Advise patients to notify the provider if diarrhea occurs, as this is an indication of potentially life-threatening superinfection of the bowel.
Macrolides patient education
increased risk of Torsades due to prolonged QT
Which macrolide is ok for pregnancy?
erythromycin
Aminoglycosides patient education (ex. gentamicin, tobramycin, amikacin)
use is associated with ototoxicity and nephrotoxicity
Prescribing sulfonamides during pregnancy
not safe (especially in first trimester)- causes birth defects
if taken near term, infant can develop kernicterus (brain damage caused by too much bilirubin)
Which cephalosporins may induce a disulfiram-like reaction if alcohol is ingested?
Cefazolin and cefotetan
sulfonamides patient education
complete full course even if symptoms resolved
take with 8-10 glasses of water or noncaffeinated beverages per day to decrease risk of crystalluria
protect skin from sun
no tanning beds
monitor for hypersensitivity symptoms
sulfonamides renal dosing
Avoid in older adults for
For patients with creatinine clearance <30mL/min:
For patients concurrently prescribed warfarin, avoid trimethoprim/sulfamethoxazole, macrolides, and ciprofloxacin
do not give if creatine is under 15
Gentamicin (aminoglycoside)
monitor Cr cl in elderly
renal adjustments
If renal dx dose reduces or dosing interval increased
What do we need to be aware of in our female patients of childbearing age with clindamycin
decrease oral contraceptive activity
Aminoglycosides are safe for what age group
children (infant <8 days old)
Clindamycin can be used as an alternative to what
penicillin
Specific drug to treat aspergillosis
Voriconazole
Which ones carry risk for hypotension with patients on antihypertensives?
Ivermectin and Moxidectin
Which ones can cause bone marrow suppression and liver impairment?
Albendazole and Mebendazole
Which is generally safe to give without obtaining baseline data?
Pyrantel Pamoate
How to treat tinea capitis aka ringworm
Drug Class – Oral antifungal (not topical)
Oral griseofulvin taken for 6-8 weeks, is considered standard therapy
Budesonide risks of use in children
risk for delayed growth
Ketoconazole and omeprazole concurrently- what does the patient need to know
decrease absorption of ketoconazole and reduce effectiveness
Which weight loss drug(s) are associated with a suicide risk in children, adolescents, and young adults?
Naltrexone and bupropion (contrave)
Which weight loss drugs are DEA scheduled drugs?
Diethylpropion
Locaserin
Phentermine/topiramate (Phentermine is scheduled, not topiramate)
Phendimetrazine
At what BMI level should bariatric surgery be considered?
BMI 35 or more
Topiramate -Therapeutic effect
induces sense of satiety (Sense of satisfaction- don’t feel hungry)
How to discontinue phentermine and/or topiramate
if the person has not lost 5% of weight loss by 6 months then d/c medication
tolerance can develop n 6-12 weeks
Which of the following would be contraindicated to prescribing phentermine/topiramate?
glaucoma, hyperthyroidism, hypertension
Orlistat patient education (orlistat acts in the GI tract to reduce absorption of fat)
may cause hypothyroidism in patients taking levothyroxine (two drugs should be administered 4 hours apart)
take vitamins A, D, E, and K
stools often fatty or oily and fecal incontinence can occur (bulk forming laxative)
taken with food
vitamin k deficency can occur and compound effects of warfarin, so coagulation must be monitored
taking more of the meds in a day won’t help weight loss
not for patients with malabsorption issues or cholestasis
Liraglutide- Baseline data needed
Ha1C, lipids, renal function
Ongoing monitoring/assessment needs – Liraglutide
assess for s/s of cholecystitis, pancreatitis, depression, and suicidal thoughts
do not give to someone with thyroid cancer or history of thyroid cancer
Loarcaserin- Baseline data needed
baseline assessment to rule out valvular disorders and pulmonary hypertension
Ongoing monitoring/assessment needs – Loarcaserin
CBC w/ differential for s/s of blood dyscrasias
Naltrexone/bupropion (contrave)- Baseline data needed
blood glucose, liver function, renal functions, and mental status
Ongoing monitoring/assessment needs – Contrave (Naltrexone/bupropion)
periodic assessments for blood glucose, liver and renal function, s/s of depression, anxiety, panic attacks, or suicidal ideation, and mania
think naltrexone (opioid antagonist) so pain medicine will not work for them
Phentermine baseline data needed
cardiac assessment
On-going monitoring/assessment needs
Ongoing assessment of cardiac status
Organic sunscreen needs what ingredient to be effective?
Avobenzone
1st line treatment for mild to moderate acne
Benzoyl peroxide (both an antibiotic and kerolytic)
1st line treatment for severe acne
Doxycycline and isotretinoin and retinoids
How to treat glaucoma in someone with COPD or asthma
Betaxolol
Latanoprost- Side effects
harmless heightened brown pigmentation of the iris and eyelid
blurred vision, burning, stinging, conjunctival hyperemia or edema, and punctate keratopathy
Allergic Rhinitis- Monoclonal antibody drug treatment option
Omalizumab (treats asthma and seasonal allergic rhinitis)
How to treat otomycosis
Thorough cleaning and application of 2% acetic acid solution or antifungal 3-4 times a day for 7 days
Causes of excessive cerumen in ear
usually caused by pushing excess cerumen deeper into the ear while cleaning
treatment of excessive cerumen in ear
irrigation of ear canal with warm water or saline
Debrox drops may assist with cerumen disimpaction by softening the wax and making it easier to remove, but it does not prevent acute otitis externa
This pathogen is highly associated with CAP in smokers and those with COPD
Haemophilus influenzae
What antibiotics can be prescribed SAFELY throughout pregnancy?
penicillin’s, cephalosporins, erythromycin
Second line treatment for CAP (if amoxicillin doesn’t work)
Respiratory fluoroquinolone
The patient was treated with an antibiotic in the last 90 days of contracting CAP what type of antibiotics should be prescribed?
quinolone (ex. fluoroquinolone)
Tendonitis/tendon rupture is highly associated with which antibiotic class?
fluoroquinolone (why they should be avoided in pregnancy)
Anthelmintic safe for pregnancy
Praziquantel
anthelmintic’s safe for breastfeeding
Mebendazole
pyrantel pamoate
anthelmintic’s caution with breastfeeding/pregnancy
albendazole
ivermectin
diethylcarbamazine
Risks with didanosine
lactic acidosis, severe hepatomegaly with steatosis, severe pancreatitis
Voriconazole (-azoles) should NOT be combined with what
drugs that are P450 inducers (Phenobarbital), reduce levels of Voriconazole
What is Enterobius vermicularis?
Pinworm infestation (Nematode)
Most common in US
pinworms in ileus and large intestine
symptoms – perianal itching and sleep disturbance
Once itching/on hands can spread through touching
Who would you expect to have Enterobius vermicularis?
Primarily in children (spread through daycares/schools)
How to treat Enterobius vermicularis?
Medication: albendazole, mebendazole, pyrantel pamoate
Hand washing, all family members should be treated at same time
Monitoring needs for long term antifungal use
Liver function – AST, ALT, alkaline phosphate, and bilirubin
How to treat systemic fungal infections
Treating systemic mycoses can be difficult: these infections often resist treatment and hence may require prolonged therapy with drugs that frequently prove toxic.
Aspergillosis – voriconazole
candidiasis- amphotericin B or fluconazole plus or minus flucytosine
Histoplasmosis- amphotericin B or itraconazole
adverse effects of abacavir
Lactic acidosis, a severe hepatomegaly with steatosis
risks with saquinavir
Use caution in patients with structural heart dx, cardiac conduction disturbances, and ischemic heart disease and taking other drugs that prolong PR interval
How to measure success with antiretroviral therapy for HIV
reduction in plasma HIV RNA
What does an increase in CD4 indicate?
increase in CD4, reduction in viral load indicating restoration of immune function
When do use foscarnet in HIV+ patients?
Used to treat cytomegalovirus (CMV) and CMV-related ophthalmic retinitis in individuals with AIDs and who have been unable to tolerate gancyclovir. Also approved for use in immunocompromised patients with HSV with resistance to acyclovir. “It has no use in treating HIV because it does it does not have antiretroviral properties” (NIH)
PR interval impacts use of which HIV drugs
atazanavir, saquinavir, lopinavir, ritonavir
Metronidazole patient teaching
do not take with alcohol to prevent a disulfiram-like reaction
mechanism of action with antihistamines
H1 blockers bind selectively to H1-histaminic receptors, thereby blocking the actions of histamine at these sites. These drugs can relieve sneezing, rhinorrhea, and nasal itching; however, they do not reduce nasal congestion.
cromolyn mechanism of action
Suppresses release of histamine and inflammatory mediators from mast cells
therapeutic action of guaifenesin
expectorant – thins secretions and loosens mucous
patient education needed for isotretinoin (Accutane)
protect skin from sunlight, avoid sunlamps and tanning beds
pregnancy should be avoided, and two reliable birth control methods used
risk for depression and suicide
What is the first line treatment of acute otitis media
high dose amoxicillin
what is likely the etiology for an elderly patient with conductive hearing loss
cerumen impaction
best predictor of otitis media
middle ear effusion
avoid supplements that contain vitamin A when taking
Isotretinoin
Treatment of acute otitis media in pediatric patient
amoxicillin 40-45mg/kg BID
Sympathomimetics mechanism of action
nasal congestion by activating a1- adrenergic receptors on nasal blood vessels. This causes, vasoconstriction, which, in turn, causes shrinkage of swollen membranes followed by nasal drainage
do not decrease sneezing, itching, or rhinorrhea.
What is the most effective drug for prevention and treatment of seasonal perennial rhinitis?
Intranasal glucocorticoids
Glucocorticoids- Therapeutic action in allergic reactions
prevents inflammatory response to allergens and reduce symptoms
s/e slowed growth in kids, nasal irritation
Salicylic acid patient education
Cleansers and mask should be rinsed off after use. Decrease number of applications for excessive skin dryness, peeling, or irritation.
benzoyl peroxide (topical) side effects
skin redness, stinging, dryness, peeling, photosensitivity. Hypersensitivity reactions in asthma patients
benzoyl peroxide patient teaching
If signs of severe local irritation occur (e.g., burning, blistering, scaling, swelling), the frequency of application should be reduced. Do not use Benzoyl peroxide with Dapsone to avoid skin discoloration. If excessive stinging occurs, wash off medication with mild soap and water then resume use the next day.
Patient education for loarcaserin
increase in hypoglycemic episodes (if diabetic)
since it can cause hypoglycemia, patients should not increase insulin dose
not for women who are pregnant
contrave (naltrexone/bupropion) patient education
stop for a few days if going to dentist
Why might a patient being treated with contrave for obesity not have therapeutic effects from hydrocodone after dental procedure
contrave contains naltrexone
antifungals to use in immunocompromised patients
fluconazole and ketoconazole for oral candidiasis
what antifungal can you not give to immunocompromised patients
amphotericin B
first line agent for someone with glaucoma
lantanoprost
sources;
https://www.chamberlain.edu/
https://www.chamberlain.com/