NR565 / NR 565 Final Exam (Latest 2024 / 2025): Advanced Pharmacology Fundamentals – Chamberlain

NR-565 Advanced Pharmacology Fundamentals
Final Exam
Smoking cessation – what works best?
Correct Answer:
one drug and counseling work best together. Chantix most effective
(cardiovascular risk).
Nicotine replacement s/e
Correct Answer:
local irritation where the substance enters the body
How does nicotine replacement work
Correct Answer:
help with withdrawal cravings
Nicotine patch
Correct Answer:
steady level of nicotine

Nicotine gum
Correct Answer:
unpleasant taste, requires good chewing technique, can’t eat or drink, can
damage dental work, hard with dentures
Nicotine nasal spray
Correct Answer:
fasted nicotine delivery and highest nicotine levels that can be achieved,
most irritating
Wellbutrin/Bupropion are
Correct Answer:
Nicotine free
Wellbutrin contrainidications
Correct Answer:
history of seizure, anorexia, nervosa, cocaine use and alcohol withdraw.
Bupropion s/e
Correct Answer:
serious neuropsychiatric effects

Recommended length of treatment for bupropion
Correct Answer:
12 weeks
What constitutes drug resistant TB
Correct Answer:
Drug-resistant tuberculosis occurs when TB bacteria become resistant to the
drugs used to treat the disease and includes multidrug-resistant (MDR TB)
and extensively drug-resistant (XDR TB).
Treatment of TB in a pregnant person, what all should be included?
Correct Answer:
A 9-month regimen of isoniazid is recommended for pregnant women and
should also receive pyridoxine supplements.
Isoniazid (INH)
Correct Answer:
a drug that can be used to prevent TB in people that have been exposed.
Rifabutin TB
Correct Answer:
deemed the safest during pregnancy.
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What labs are used to diagnose hypo/hyper thyroid?
TSH, T3, and T4. High TSH = hypo and low TSH = hyper. Opposites.

Timeframe for re-check of labs after starting levothyroxine
6-8 weeks (long half-life). Yearly after stable.

Signs and symptoms of hypothyroidism
Dry hair, puffy face, goiter in the neck, slow heartbeat, weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold intolerance.

Drug of choice for hypothyroidism
Levothyroxine (Synthroid)

§ Signs and symptoms of hyperthyroidism
Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss, diarrhea, menstrual periods loss often or longer.

Drug of choice for hyperthyroidism
Methimazole (Tapazole)

Treatment of thyroid storm
high doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids and IV fluids.

Result of not treating hypothyroidism during pregnancy:
Permanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester.

Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself):
Beta blockers (tachycardia) – propranolol/atenolol most popular.Non-radioactive iodine. ADJUNCTIVE THERAPY.

Drug/Food/Supplement interactions with levothyroxine:
Do not take antacids, Calcium or Iron, how to take it (morning 30-60 min b4 eat.

How to confirm a diagnosis of DM prior to beginning treatment:
Fasting plasma glucose above 126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of over 200, or a A1C higher than 6.5.

A1c general goals
<7, patients that experience severe hypoglycemia/have a limited life expectancy may have an A1C goal of <8.

A1c older adults
<8, those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals such as <8.0-8.5.

When should insulin be considered?
For treatment of persistent hyperglycemia starting at a threshold of >180.
Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if symptoms of hyperglycemia are present, or whenA1C levels >10% or BGS >300

At what time interval should A1c be re-checked?
How often should an A1C be monitored when stable or when unstable?
Every 2-3 months and max of 4 times a year. If <7, every 6 months.

At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals.

Action of Insulin
Anabolic, energy conservation, promotes cellular growth and division.

Pioglitazone contraindications:
Heart failure (severe = no, mild = caution) and bladder cancer. Causes fluid retention.

GLP-1 (abbreviation and examples)
Glucagonlike Peptide – Subcutaneous injections – Dulaglutide (Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).

SGLT2i (abbreviation and examples)
Sodium Glucose Cotransporter 2 Inhibitors – Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).

DPP4-I (abbreviation and examples)
Dipeptidyl Peptidase-4 Inhibitors – Sitagliptin, Saxagliptin, Linagliptin, Alogliptin.

TZD (abbreviation and examples)
Thiazolidinediones – Rosiglitazone & Pioglitazone

Which drug class should be considered for diabetes prior to insulin?
It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated.

Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin
Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD)

Example: TDD = patient’s weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting.

How is total daily dose (TDD) of insulin calculated
TDD is calculated by taking the total weight in kg and multiply by 0.6 units.

Know the carbohydrate-to insulin ratio when calculating basal insulin
Mealtime dose is calculated using the 450 rule for regular insulin and 500 rule for rapid acting insulin then divide by TDD. The answer (rounded) = the ratio of 1:the # answer. That means that if the meal is 60g of carbs, 60 divided by the # in answer = # of units of rapid-acting insulin.

GLP-1 MOA
slows gastric emptying, stimulates glucose dependent insulin release, and suppresses glucagon release and reduces appetite

DPP-4i MOA
Enhance the activity of incretins and thereby increase insulin release, reduce glucagon

TZD MOA
Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue

Sulfonylureas MOA
promote insulin secretion by the pancreas.

HYPOGLYCEMIA

SGLT2i MOA
Kidney tubules.

Which diabetic medication(s) come with a concern of hypoglycemia?
Insulin, meglitinides, sulfonylureas, amylin analogues

Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200 mg/dL.
*Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss.
· Diabetes mellitus
· Pre-diabetes
· Diabetes mellitus

Fasting plasma glucose greater than or equal to 126 mg/dL. *Fasting is defined as no caloric intake for at least 8 hours.
· Pre-diabetes
· Diabetes mellitus
· Diabetes mellitus

2 hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL. The test uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
· Pre-diabetes
· Diabetes mellitus
· Diabetes mellitus

HgbA1c greater than or equal to 6.5%
· Pre-diabetes
· Diabetes mellitus
· Diabetes mellitus

Fasting plasma glucose 100 to 125 mg/dL (IFG) or
· Diabetes mellitus
· Pre-diabetes
· Pre-diabetes

Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of standard glucose load (75 g) or
· Diabetes mellitus
· Pre-diabetes
· Pre-diabetes

HgbA1c 5.7% to 6.4%
· Diabetes mellitus
· Pre-diabetes
· Pre-diabetes

Methylxanthines (Theophylline)

Who is at risk for toxicity and why?
smokers require higher doses. Heart disease liver disease require lower doses. INITIAL doses are based on age and weight. P.569 low therapeutic range. Smoking causes increased clearance so if stop smoking levels will rise to toxic levels.

Step 1 therapy for asthma and COPD
Manage with a SABA (albuterol) as needed.

Symptoms associated with intermittent asthma frequency
2 days/week or less

Symptoms associated with mild-persistent asthma frequency
More than 2 days/week but less than daily

Symptoms associated with moderate-persistent asthma frequency
Daily

Symptoms associated with severe-persistent asthma frequency
Several times a day

SABA drug class examples
Albuterol (proair, ventolin, Proventil), levalbuterol (Xopenex).

LABA drug class examples
Aclidinium bromide, arformoterol (brovana), formoterol, indacaterol, olodaterol, salemetrol.

ICS (Inhaled corticosteroids) drug class examples
Beclomethasone dipropionate (QVAR), Budesonide (Pulmicort), Ciclesonide (Alvesco), Flunisolide (Aerospan), fluticasone propionate (Flovent), Mometasone furoate (asmanex).

SABA Benefits of use
Used PRN for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma attacks and COPD exacerbations.

Patient instructions for SABA
Proper use/technique of inhaler.Consider spacer in difficulty with hand-breath coordination.Patients keep a record of symptom frequency, intensity, nighttime awakenings, effect on normal activity, and SABA use.Report CP or changes in rhythm.When two inhalations are needed, an interval of at least 1 minute should elapse between inhalations.Warn against exceeding recommended doses.

Why is it important to know the frequency a patient is using their SABA?
SABA use is a marker of inadequate asthma control

LABA (long acting beta2-agonists)
Should be taken on a fixed schedule, not PRN and always in combination with an inhaler glucocorticoid.

Examples of LABA
Aclidinium bromide, arformoterol, formoterol, indacaterol, olodaterol, salmeterol.

Benefits of use – LABA
Maintenance therapy.

Use in COPD – LABA
May be used alone in patients with COPD. Drug therapy is minimal and limited to a small improvement in symptoms.

Inhaled ICS examples
Beclomethasone dipropionate, Budesonide, Ciclesonide, Flunisolide, Fluticasone proprionate, Mometasone furonate.

Benefits of use – ICS
Suppresses inflammation, reduce bronchial hyperreactivity and decrease airway mucus production.

At what point would an oral steroid be prescribed?
Patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD. Only prescribed when symptoms cannot be controlled with safer meds (inhaler glucocorticoids, inhaled B2 agonists).

When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor)
Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations.

Smoking cessation – what works best?
one drug and counseling work best together. Chantix most effective (cardiovascular risk).

Nicotine replacement s/e
local irritation where the substance enters the body

How does nicotine replacement work
help with withdrawal cravings

Nicotine patch
nonprescription, provides a steady level of nicotine; easy to use; unobtrusive

Nicotine gum
unpleasant taste, requires good chewing technique, can’t eat or drink, can damage dental work, hard with dentures

Nonprescription; user controls doses

Nicotine nasal spray
fasted nicotine delivery and highest nicotine levels that can be achieved, most irritating

Wellbutrin/Bupropion are
Nicotine free

Wellbutrin contrainidications
history of seizure, anorexia, nervosa, cocaine use and alcohol withdraw.

Bupropion s/e
serious neuropsychiatric effects

Recommended length of treatment for bupropion
12 weeks

What constitutes drug resistant TB
Drug-resistant tuberculosis occurs when TB bacteria become resistant to the drugs used to treat the disease and includes multidrug-resistant (MDR TB) and extensively drug-resistant (XDR TB).

Treatment of TB in a pregnant person, what all should be included?
A 9-month regimen of isoniazid is recommended for pregnant women and should also receive pyridoxine supplements.

Isoniazid (INH)
a drug that can be used to prevent TB in people that have been exposed.

Rifabutin TB
deemed the safest during pregnancy.

cold and cough meds actions (3)
Decongestants decrease stuffiness. Antitussives suppress coughing. Expectorants help to clear out mucous.

examples of decongestants
Beclomethasone dipropionate, budesonide, fluticasone, triamcinolone.

Which drug class has no significant drug interactions: cold and cough
expectorants

H2 receptor antagonists examples
Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac).

Which is most likely to interact due to CYP450 enzyme system?
Cimetidine (Tagamet)

Proton Pump Inhibitors
First-line therapy. Omeprazole (Prilosec), esomeprazole (nexium), pantoprazole (protonix)

Associated vitamin and/or mineral deficiencies with PPI
Decreased absorption of calcium, magnesium, and vitamin B12.

Short term use increases risk of what with PPI
Community-acquired pneumonia (CAP, first few days), rebound GERD- use lowest does for shortest period of time and tapper. Can persist for several months after PPI dc, diarrhea (dose related) Cdiff

How to treat moderate to severe GERD
Long-term maintenance therapy of PPI is recommended for severe. Moderate???

What medication for GERD to avoid in older adults and why?
Renal (famotidine aka Pepcid), Ranitidine and cimetidine due to risks for mental status changes, nizatidine (axid) heart and liver.

Treating GERD during pregnancy
Some PPIs (esomeprazole) and H2 receptor antagonists (ranitidine) are safe for use in pregnancy.

Which cytoprotective agents would be used:
Sucralfate – NOT misoprostol

When to test for H. Pylori:
If on treatment and not getting better. Consider testing before prescribing H2 receptor antagonists/PPIs.

How to treat H. Pylori
Continue PPIs for 8-12 weeks, low-risk maybe no treatment, high-risk may require chronic acid suppression therapy. GI referral if no relief.

Lifestyle modifications to support ulcer healing
Stop smoking, change in eating pattern (smaller meals and avoiding caffeine), avoid aspirin and NSAIDs, stop alcohol consumption, decrease stress and anxiety.

Which antidiarrheal contradicted in children during or after chickenpox
Salicylate component of pepto

Patient teaching for ciprofloxacin for traveler’s diarrhea: Neena is planning missionary work in a region with poor drinking water. She is given a prescription for ciprofloxacin to take with her. Which of the following instructions are most important to discuss with Neena?
· Use the drug if symptoms develop and are severe or do not improve in a few days.

Which one associated with gray/black stools and black tongue
Pepto – result from bismuth that make up pepto.

· Constipation
Lifestyle modifications to suggest prior to treatment
Increasing fiber and fluid in the diet, mild exercise.

Risks of laxatives during pregnancy
Gastrointestinal stimulation can induce labor.

Preferred treatment during breastfeeding constipation
senna

Psyllium
bulk forming laxative and can cause fecal impaction or obstruction.

How psyllium works and what to assess for if it doesn’t produce a bowel
Absorb water, thereby softening and enlarging the fecal mass.

obstruction

Irritable Bowel Syndrome (IBS)
A diary can be helpful to aid in diagnosis and treatment. Logging food and stressors that trigger symptoms, different for different people. Diagnosed by Rome IV criteria.

Nonspecific drugs to treat IBS
Antispasmodics (Hyoscyamine and dicyclomine), bulk-forming agents (psyllium and polycarbophil), antidiarrheals (loperamide), and tricyclic antidepressants (TCAs).

How to treat gastroparesis:
Prokinetic drug is best

Black box warning associated with treatment (prokinetic drug)
Risk of developing tardive dyskinesia

Patient teaching needed with Metronidazole
Tardive dyskinesia risk increases with length of treatment, treatment should not exceed 12 weeks, immediately discontinue with signs of movement disorder including repetitive involuntary movements of arms, legs, and facial muscles. Older adults are especially vulnerable.
Never used during first trimester of pregnancy

The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. Which of the following medications should be recommended to alleviate the child’s constipation? ​
· Magnesium citrate
· Methylcellulose​
· Bisacodyl suppositories​
· Polyethylene glycol​
· Polyethylene glycol​

Sodium phosphate is a routine order for bowel cleansing before a colonoscopy. The patient’s lab tests report an elevated creatinine clearance and blood urea nitrogen. What is the best course of action for this patient?​
· Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead​
· Suggest that the patient reduce the dietary sodium intake
· Reduce the amount of fluid given with the laxative to prevent fluid retention​
· Prescribe a laxative suppository instead​
· Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead​

An older adult patient takes an opioid analgesic after a right-hip open reduction internal fixation (ORIF). Which of the following medications should be prescribed to prevent constipation?​
· GoLYTELY​
· Docusate sodium​
· Glycerin suppositories​
· Polyethylene glycol​
· Docusate sodium​

A patient reports taking an oral bisacodyl laxative for several years. Which of the following instructions should be given to guide the discontinuation of the laxative?​
· Withdraw from the laxative slowly to avoid a rebound constipation effect.​
· Stop taking the oral laxative and use a suppository until normal motility resumes.​
· Stop taking the laxative immediately and expect no stool for several days.​
· Switch to a bulk-forming laxative, such as methylcellulose.​
· Stop taking the laxative immediately and expect no stool for several days.​

A patient who has been taking senna for several days reports that her urine is yellowish brown. Which of the following responses is the most appropriate response?​
· It indicates that renal failure has occurred.​
· It is caused by dehydration, which is a laxative side effect.​
· It is an expected, harmless effect of senna.​
· It is a sign of toxicity; this drug must be discontinued.​
· It is an expected, harmless effect of senna.​

DTaP
Five doses:

1: 2 months

2: 4 months

3: 6 months

4: between 15 and 18 months

5: between 4 and 6 years

Booster every 10 years thereafter starting at age 11 years

Who should receive the Tdap vaccine?
A booster shot with Tdap is recommended for all children 11-18 years old. every 10 years after that.

True contraindication for DTaP or Tdap vaccine:

• A shocklike state
• Fever (105°F or higher) occurring within 48 hours of vaccination and not attributable to another identifiable cause
• Persistent, inconsolable crying lasting 3 or more hours and occurring within 48 hours of vaccination
• Seizures (with or without fever) occurring within 3 days of vaccination

history of anaphylactic reaction or encephalopathy within 7 days of vaccine

Varicella Vaccine Contraindications
Pregnancy, certain cancers (leukemia, lymphomas, hypersensitivity to neomycin or gelatin, immunocompromised. Concern for Reye syndrome in children.

Hepatitis B virus (HBV) vaccine Contraindications
Soreness at injection site and mild to moderate fever. Prior anaphylactic reaction to the vaccine itself or baker’s yeast.

Attenuated vaccine
Composed of live microbes that have been weakened or rendered completely avirulent.

Live virus vaccine
Composed of living microbes that have been weakened or rendered completely avirulent.

Toxoid vaccine
A bacterial toxin changed to a nontoxic form. Administration causes the receipt’s immune system to manufacture antibodies.

DTAP, TETANUS

immunity – What are they and how is each one achieved?
Immunity is achieved through the occurrence of antibodies to a specific disease.

Herd (Community) immunity:
The resistance to an infectious organism because a large group of people is immune to the infectious organism through vaccine.

Active immunity:
The immune system produces antibodies in response to an antigen by the vaccine, or by the infection itself.

Passive immunity
The immunity that occurs naturally.

Definition of vaccine
A preparation containing whole or fractioned microorganisms. Administration causes recipient’s immune system to manufacture antibodies directed against the microbe from which the vaccine was made.

Post exposure prophylaxis for suspected rabies bite
Post exposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14.

Patient teaching and assessments for post vaccine side effects:
Local reactions (discomfort, swelling, erythema at the injection site), fever. Rare s/e are anaphylaxis, acute encephalopathy, and vaccine-associated paralytic poliomyelitis.

Who can receive attenuated influenza vaccine (FluMist)?
individuals >2yo and less than 50. non-pregnant, and those who are not immunocompromised

Live virus
*Measles, mumps, and rubella virus(MMR)
*Measles, mumps, and rubella, and varicella virus (MMRV)
*Varicella virus
*Influenza
*Rotavirus

· Toxoids
Diphtheria and tetanus and acellular pertussis vaccine (DTaP)
Diphtheria and tetanus and acellular pertussis adsorbed, hepatitis B (recombinant), and inactivated poliovirus vaccine
Tetanus and diphtheria

· Inactive viral antigen
Poliovirus vaccine, inactivated (IPV, Salk vaccine)
Hepatitis A vaccine (HepA)
Hepatitis B vaccine (HepB)
Influenza vaccine

· DNA-free virus-like particles
Human papillomavirus vaccine

· Bacterial polysaccharide conjugated to protein
Haemophilus influenzae type b (Hib) vaccine
Pneumococcal vaccine (PCV13)
Pneumococcal polysaccharide vaccine (PPSV)
Meningococcal vaccine (MCV4)

Recombinant protein solution
Meningococcal subgroup B vaccine

A patient is has just been prescribed levothyroxine. When should the NP put in a lab order to check TSH levels ?
6-8 weeks

A patient comes into the clinic complaining of sore throat and fever. She has recently started Methimazole in the last 4 weeks. What does this suggest?
Agranulocytosis. Must check CBC and LFTS for infection. Labs may not always catch in time since it progresses rapidly.

MONITOR LFTS WITH METHIMAZOLE

A newly pregnant mother shows understanding of Hypothyroidism in pregnant women by stating(Select all that apply)

1. I can keep my current dose of levothyroxine
2. I know that if I don’t take my medicine it can cause permanent damage to my baby
3. I will need to increase my dose of medicine for a short-time
4. My baby will start to make her own thyroid hormones in week 3
5. I know that if I don’t take my medicine it can cause permanent damage to my baby
6. I will need to increase my dose of medicine for a short-time

What is the role of Radioactive Iodine and what is a possible adverse effect?
TO destroy thyroid tissue with those with hyperthyroidism. And/or have not responded to therapy.

Beta blockers in diabetes (atenolol, metoprolol, propanolol)
Can mask the signs/symptoms of hypoglycemia

A1C target in children/adolescents
<7%

Insulin dose calculations
1: calculate TDD by using 0.6units/kg/day
2: calculate mealtime carbohydrate-to-insulin dose by dividing 500 (for rapid acting) or 450 (for regular insulin) by TDD
3: round your number
4: now you have your carbohydrate-to-insulin ratio such as 1:10

Example: if meal is 60g of carbs, 60g divided by 10 is the # of units of insulin

A patient receives his first lab results showing an AIC of 7.2%. What is the diagnosis?
Repeat for confirmation

A random glucose of __ is considered diabetic?
A random plasma glucose of over 200

A person with diabetes has recurrent severe hypoglycemia events. What should his A1C goal be?
Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite DS

When is it okay for a patient to have an A1C goal of 6.5%?
When there are no hypoglycemic events and the patient can handle it.

A person comes in with an A1C of 10% and a fasting glucose of >300, what are the next steps for the provider?
Combination injectable therapy immediately. IF 9% can start at step 2 with dual therapy. P400

Biguanide (metformin)
Decreases glucose production by the liver

Who should not take metformin?
Severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment.
liver disease, severe infection, or a history of lactic acidosis
contraindicated for people with failing hearts

Sulfonylureas should not be used during __ or with or impairment.
Not used during pregnancy; liver or renal impairment

What is the TDD of a person that weighs 70kg?
If a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question?
TDD = 42
500/42 = 12 rounded
50/12 = 4 units of insulin

A patients states that she will take her Insulin lispro 30-60 minutes before a meal.
Lispro onset is 15-30 mins

Mixing insulins
When a mixture is prepared, the short-acting insulin should be drawn into the syringe first to avoid contaminating the stock vial of the short-acting insulin with NPH insulin.

Canagliflozin s/e
female genital fungal infections, urinary tract infections, and increased urination.

A patient taking Sitagliptin reports abdominal pain with vomiting. What are your next steps?
Concern for pancreatitis

Lifespan considerations for methylxanthines
•Rates of metabolism are affected by age. For nonsmoking adults half-life is about 8 hours. Smoking can accelerate it. Half-life in kids is 4hrs

LABA MOA
A sympathomimetic drug that activates B2 adrenergic receptors. This promotes broncho dilation and thus relieving bronchospasm. Has limited role in suppressing histamine release in the lung.

A patient wakes up at night a few times a week, has been using his SABA daily, and has been experiencing symptoms daily, and states he cannot make it up flight of stairs without trouble breathing. What is his severity of his asthma symptoms and what step should be considered?
Moderate persistent asthma Step 3- not well controlled: SABA PRN, low dose IGC and LABA OR medium dose IGC

What are some benefits of using ICS?
very effective, safer than systemic, usually minor adverse reactions

tdap
A booster shot with Tdap is currently recommended for all children 11 to 18 years old. Boosters with Tdap are given every 10 years thereafter.

Varicella contraindications
pregnant, weakened immune, HIV/AIDS with T-cell <200, cancer, high-dose steroids

Hep B contraindication
Baker’s yeast

Live vaccine contraindications
Immunocompromised children (special risk from live vaccines, and therefore should be avoided). Pregnancy.

A patient has a TSH of .28, a free T4 of 3, and a free T3 over 650. What medication should she be started on?
Methimazole, PTU, radioactive iodine. These labs indicate hyperthyroidism. Treatment for thyroid storm: K iodide or strong iodine solution to suppress thyroid release. Methimazole to suppress thyroid synthesis. Normal TSH 0.4-4.0, Free T4 0.7-2.0, Free T3 0.26-0.48.

When is it appropriate to increase insulin needs?
Pregnancy (after first trimester), stress, infection, weight loss, adolescent growth spurt. DECREASE for exercise and first trimester.

What is the TDD of a person that weighs 70kg?

IF a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question?
42 TDD : 21 basal 21 bolus (Wt in kg x 0.6; 50% long acting and 50% rapid acting)

500 divided by (the TDD) 42 = 12. (carb to insulin ratio) then (meal carbs) 50 divided 12= 4.1 units with short acting insulin

“As long as the short-acting insulin is drawn up first I can mix my insulin glargine with it.”
Of the long-acting medications, ONLY NPH the intermediate duration is suitable for mixing with the short action insulins.

A women who is taking Pioglitazone states, “I’m glad that this medication promotes weight loss.”
Medication promotes an increase in LDL levels, which increases cardiovascular risk. Also, she is a female, so provide education on exercise and weight-bearing exercise d/t possible increased risk for fractures.

Glucocorticoid MOA
Most effective in long-term control of airway inflammation

Cromolyn MOA
Used as prophylaxis for mild to moderate asthma

Monoclonal Antibodies MOA
Used for allergy-related asthma and Eosinophilic asthma. Omalizumab for allergy related and Ben ralizumab, mepliz, and resliz are for eosinophilic

Leukotriene MOA
Second-line therapy to reduce inflammation and bronchoconstriction

B2 adrenergic agonists MOA
Can be used PRN, for EIB, COPD exacerbations, and maintenance therapy

methylxanthines MOA
Maintenance therapy for chronic stable asthma (theophylline). P. 570. Use ONLY if B2 or anticholinergics are not appropriate.

anticholinergic MOA
Approved for bronchospasm related to COPD

•What are some risk factors of fatal asthma attacks?
Uncontrolled, recently hospitalized, triggers,

•Roflumilast
Reduces inflammation, not intended for pregnancy, approved only for COPD, Second-line drug for COPD

Uses for exacerbations prophylaxis in pts with severe COPD with a primary chronic bronchitis component.

What pt education can you provide a patient for ICS use?
Rinse d/t oropharyngeal candidiasis and dysphonia (hoarseness, difficulty speaking).

What patient teaching can a provider give when prescribing a PPI?
Hypomagnesia symptoms: muscle cramps, tremors, cramps, and palpitations. Check Mg levels periodically especially in the elderly. Get enough calcium and VIT D. call if having diarrhea (Cdiff)

What patient teaching can a provider give when prescribing an H2RA? *Histaime type 2 Receptor Agonist
Report lethargy, solmnolance, restlessness, confusion or hallucinations. (CNS effects). Teach about possible reduced libido, impotence, gynecomastia, pneumonia. P.594 Cimetidine interacts with CYP system so check with pt if they are taking warfarin, phenytoin, theophylline, lidocaine.

A patient presents with a complaint of reflux and constipation. He states that he drinks enough water, and admits he has gained 30lbs. He also states that he has been having “reflux” type symptoms. What are your next steps for education?
Educate that weight gain can promote reflux symptoms, ask about any otc use such as antacids which may cause constipation.

zollinger-Ellison syndrome is due to a _______producing tumor. Treatment is long-term therapy of what medication class?
gastrin…….PPI’s

•A patient who takes NSAIDS almost daily for arthritic pain and refuses to try another medication is at risk for an NSAID-induced ulcer. The provider states:
I will start you a PPI to prevent an ulcer
a PPI is the first-line choice, Misoprostol can cause diarrhea.

A young woman who was in a car accident 4 months ago takes NSAIDS for pain-related injuries. She has been dx with an ulcer and taking Misoprostol. She also has found out she is pregnant. What is the providers next steps?
Switch her to a PPI d/t possible miscarriage.

A patient comes into the clinic with complaints of bloating and abdominal pain for a few weeks. What are appropriate options for treatment?

Lifestyle modifications and H2RA
Lifestyle mod H2RA

•A patient has tested positive for H.Pylori what are appropriate treatment options?
start PPI, Start abx for 10-14 days.

•A pregnant woman comes in asking for GERD medication, what can you recommend?
sucralafate

Metoclopramide can be used for (select all that apply)
1.Nausea and vomiting
2.Diabetic gastroparesis
3.Gastroesophageal reflux
all

•What TB medication is not safe for pregnancy?
Ethambutol shows teratogenesis in animal studies and eye abnormalities in children. Rifabutin is the safest in pregnancy.

•What constitutes drug resistant TB?
Resistant to isoniazide and Rifampin. 700

•IF a mother is taking isoniazid and rifampin, can she breastfeed?
Yes, any other drug you would have to weigh benefit vs risk.

•What to assess if Psyllium does not work?
Fecal impaction

Bulk-forming laxatives
Work much like dietary fiber producing stool in 1-3 days

Stimulant
•Stimulate intestinal motility

Osmotic
High doses are used for bowel prep

Surfactant MOA
. lowers surface tension which facilitates penetration of water into feces

Black box warning associated with treatment for gastroparesis
Reglan preferred treatment- tardive dyskinesa

• patient teaching for metronidazole
  s/e of nausea and vomiting
  alcohol must be avoided
  should not be taken during pregnancy

black box warning: associated with increased carcinogenic risk in mice and rats. unnecessary use is to be avoided.