Answer:
Opioid induced constipation
Q: If you give an elderly patient lactulose every day what do you need to monitor?
Answer:
Electrolytes
Q: Inappropriate use of antimicrobials?
Answer:
Creates resistance to the medications
Q: What is an antibiogram?
Answer:
Every hospital has this, chart of the local resistance patterns that are being monitored
Q: Carbamazepine has a lot of warnings, black box warning for what allele?
Answer:
Asian ancestry has an increased risk for steven johnsons syndrome
“Burning man rash”
Powered by https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\n
First line tmt for a previously healthy person who develops CAP?
Azirthomycin<\/p>\n\n\n\n
If you see SSRI (selective serotonin reuptake inhibitor) and St. John’s wort together?
Serotonin syndrome<\/p>\n\n\n\n
Hypersensitivity with Phenytoin?
3-8 weeks after treatment can occur (overly sensitive to this medication and have adverse reactions)<\/p>\n\n\n\n
This would look like a characteristic rash, fever, leukocytosis<\/p>\n\n\n\n
Carbamazepine can auto-metabolize?
YES.<\/p>\n\n\n\n
This can auto-metabolize so you will end up with lower levels<\/p>\n\n\n\n
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<\/p>\n\n\n\n
INCREASE the dose<\/p>\n\n\n\n
Carbamazepine black box?
Steven Johnsons Syndrome<\/p>\n\n\n\n
Carbamazepine monitoring
Monitor a CBC, every 3-4 months to watch for agranulocytosis<\/p>\n\n\n\n
Gabapentin
This affects GABA, and is used to treat neurontin pain<\/p>\n\n\n\n
When you drink alcohol there are more GABA production<\/p>\n\n\n\n
A patient is on gabapentin and having strange thoughts, what do you need to ask them?
You need to ask about suicidal ideation<\/p>\n\n\n\n
Worried about a patient having a reaction to lamotrigine?
This has a high risk for hypersensitivity<\/p>\n\n\n\n
How do Lamotrigine and oral contraceptives interact?
Reduces the lamotrigine levels thus you end up increasing the lamotrigine dose<\/p>\n\n\n\n
TCA antidepressants, what comorbidities should you avoid when prescribing them?
Cardiac disease<\/p>\n\n\n\n
How long are we going to tell patients that they are going to see a response with an SSRI?
2-6 weeks<\/p>\n\n\n\n
If you have a schizophrenic patient and you give them haldol what do you assess for?
Extrapyramidal symptoms (EPS)<\/p>\n\n\n\n
Do not need peak and trough. Should have continuous EKG but EKG will not help monitor for EPS.<\/p>\n\n\n\n
Will the beta agonist overpower the digoxin?
A beta agonist anything with dysrhythmia will speed up the HR<\/p>\n\n\n\n
Digoxin is dysrhythmic and slows down the HR.<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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)<\/p>\n\n\n\n
Black box warning is that reports for severe asthma exacerbations occur thus causing death<\/p>\n\n\n\n
Spiriva
inhales anticholinergics used for the tmt of COPD<\/p>\n\n\n\n
If you prescribe someone with beclomethasone how should they use it?
Inhaled corticosteroid<\/p>\n\n\n\n
Rinse and spit after, spacers are good<\/p>\n\n\n\n
USE EVERYDAY, this is not a PRN inhaler<\/p>\n\n\n\n
Montelukast(singular) side effects?
Aggression, anxiety, depression and suicidal ideation are mental health issues when taking this medication<\/p>\n\n\n\n
How are we going to get an elderly old man to not take benadryl?
Causes urinary retention<\/p>\n\n\n\n
Why do we use the second generation antihistamines more often for seasonal allergies?
They are more selective which makes them less sedative<\/p>\n\n\n\n
When you take calcium carbonate antacids chronically what do they put themselves at risk for?
Kidney stones<\/p>\n\n\n\n
Patients on long term PPI (can create osteoporosis through calcium decrease absorption) can also have what else occurs?
Iron deficiency<\/p>\n\n\n\n
Vitamin B12 deficiency<\/p>\n\n\n\n
anemia<\/p>\n\n\n\n
osteoporosis<\/p>\n\n\n\n
Methylnaltrexone is used to treat?
Opioid induced constipation<\/p>\n\n\n\n
If you give an elderly patient lactulose every day what do you need to monitor?
Electrolytes<\/p>\n\n\n\n
Inappropriate use of antimicrobials?
Creates resistance to the medications<\/p>\n\n\n\n
What is an antibiogram?
Every hospital has this, chart of the local resistance patterns that are being monitored<\/p>\n\n\n\n
Carbamazepine has a lot of warnings, black box warning for what allele?
Asian ancestry has an increased risk for steven johnsons syndrome<\/p>\n\n\n\n
“Burning man rash”<\/p>\n\n\n\n
Chromyln eye drops can they wear their contacts?
No they are not allowed to<\/p>\n\n\n\n
First line drug for a moderate GAD?
Buspar<\/p>\n\n\n\n
Working someone up for depression, what lab do you get?
Thyroid<\/p>\n\n\n\n
Good drug for treatment with depression and anxiety?
Lexapro<\/p>\n\n\n\n
Go to taper an SSRI you do this how?
You reduce the dose for 50% for 3-4 days then
Then reduce by 50% after that<\/p>\n\n\n\n
If you prescribe someone fluoxetine (SSRI), why is it important they take it the same time every day and do not run out of their rx)?
Short half life<\/p>\n\n\n\n
Rule with asthma, when do you do up or down?
If they use their SAB more than 2x a week you adjust<\/p>\n\n\n\n
If your asthma patient is on an inhaled beta agonist and an inhaled steroid which one do you tell them to use first?
The beta one is to be used first to bronchodilator them then use the steroid.<\/p>\n\n\n\n
When you get a tmt plan for asthma what do you need to know?
Severity, and control<\/p>\n\n\n\n
How bad, how long do they last, how often<\/p>\n\n\n\n
TMT for mild intermittent asthma?
SABA (short acting bronchodilator) then add on low dose corticosteroids<\/p>\n\n\n\n
What past medical history patients are at risk for a beta agonist attack?
Intubation or an ICU admission for asthma<\/p>\n\n\n\n
What causes antimicrobial resistance?
Inappropriate use of antimicrobials<\/p>\n\n\n\n
What’s an antibiogram?
Your pattern of local resistance<\/p>\n\n\n\n
Sensitivity and cross resistance between cephalosporins and penicillins, has what in common that causes the cross sensitivity?
Beta lactate ring<\/p>\n\n\n\n
DECREASE the dose<\/p>\n\n\n\n
If you have someone that is on long-term anti-fungal treatment, what labs are you going to monitor?
LFTs<\/p>\n\n\n\n
Ketoconazole<\/p>\n\n\n\n
What is the rule about Flagyl and alcohol?
Don’t do it<\/p>\n\n\n\n
What do we reserve fluoroquinolone for?
Community acquired pneumonia with patients with co-morbidities<\/p>\n\n\n\n
A 44 year old female with diabetes – comorbidities receive fluoroquinolones<\/p>\n\n\n\n
What is the black box warning for fluoroquinolones?
Tendon rupture<\/p>\n\n\n\n
Clindamycin
Gives people cdiff, also known as pseudomembranous colitis<\/p>\n\n\n\n
Advise the patient to discontinue the medication if the stools were 10-20 a day and start the patient on vancomycin for c.diff related diarrhea<\/p>\n\n\n\n
If you are on the medication they are at risk for C.diff, you want to know how many times a day this is happening.<\/p>\n\n\n\n
G6PD
faba beans and sulfonamides (bactrim) – develop anemia<\/p>\n\n\n\n
Do use tetracyclines in
Pregnancy – NO<\/p>\n\n\n\n
Renal dysfunction – NO<\/p>\n\n\n\n
Hepatic dysfunction – NO<\/p>\n\n\n\n
Adolescence – YES<\/p>\n\n\n\n
You have a 16-year-old girl taking Minocycline for acne has headaches
Pseudotumor cerebri<\/p>\n\n\n\n
Patient has chlamydia and is on doxycycline, on combined oral contraceptive.
Use second form of birth control<\/p>\n\n\n\n
Isoniazid causes decrease in vitamin b6
Prescribe vitamin b6 (pyridoxine)<\/p>\n\n\n\n
Valcyclovier for shingles what do you worry about?
Renal fx – drink fluids<\/p>\n\n\n\n
Conjunctivitis and AOM what would you treat with?
Amoxicillin first then augmentin<\/p>\n\n\n\n
Copious green discharge coming from the eye, gonococcal conjunctivitis
Treat with IM ceftriaxone<\/p>\n\n\n\n
If you’re going to give optomic beta blocker for glaucoma and they are on an oral beta blocker
Worry about low heart rate<\/p>\n\n\n\n
Allergic conjunctivitis do we give abx?
NO<\/p>\n\n\n\n
Cromolyn (opticrom) – can’t wear soft contact lenses<\/p>\n\n\n\n
Perforated tympanic membrane
Don’t use ciprofloxacin otic drops<\/p>\n\n\n\n
Mild to moderate anxiety
Buspar<\/p>\n\n\n\n
Depressed
Look at thyroid<\/p>\n\n\n\n
COPD what do we ask for rescue inhaler (albuterol)
How often are they using it?<\/p>\n\n\n\n
COPD exacerbation
Steroids – burst therapy<\/p>\n\n\n\n
GERD – estrogen can relax lower esophageal sphincter (hormone replacement can increase GERD)
Metoclopramide increases lower esophageal tone<\/p>\n\n\n\n
Step down approach: which medication are you treating with?
PPI<\/p>\n\n\n\n
H. pylori which medications are you looking at?
Clarithromyacin plus PPI plus Amoxicillin<\/p>\n\n\n\n
Cluster headaches what do we treat with?
Oxygen 100% for 15 – 30 minutes<\/p>\n\n\n\n
Abortive therapy for migraines
Triptins<\/p>\n\n\n\n
Prophylactic treatment for migraines
Beta Blockers<\/p>\n\n\n\n
(Propanolol)<\/p>\n\n\n\n
Community acquired pneumonia
First line tx – Azithromycin<\/p>\n\n\n\n
Community acquired pneumonia but have comorbidities
Levofloxacin<\/p>\n\n\n\n
Treat with PNA – how long to see improvement
48-72 hours<\/p>\n\n\n\n
Educate on Tratantex
Behavioral issues (neuropsychiatric symptoms)<\/p>\n\n\n\n
SI<\/p>\n\n\n\n
Swimmers ear, intact tympanic eardrum
Cipro with hydrocortisone drops<\/p>\n\n\n\n
Simple UTI in teen with no recent ABX
Bactrim PID 3<\/p>\n\n\n\n
Genital herpes outbreak
Valacyclovir<\/p>\n\n\n\n
NOT question – Osteoporosis
Calcium and vitamin D is need!<\/p>\n\n\n\n
Onychomycosis
Know risk of hepatic and renal injury – on an antifungal for that long to treat a nail infection<\/p>\n\n\n\n
Postmenopausal patient with atrophic vaginitis 59, breast cancer at age 40, what is the most appropriate treatment
Estrogen cream – not oral<\/p>\n\n\n\n
Shingles, patient is miserable
Acyclovir plus NSAIDs<\/p>\n\n\n\n
What do you prescribe for neuropathic pain with shingles
Gabapentin<\/p>\n\n\n\n
Community acquired PNA and an adult with comorbidities.
Azithromycin plus ceftriaxone<\/p>\n\n\n\n
PO for community acquired MRSA soft tissue infection
Bactrim<\/p>\n\n\n\n
What drug causes long term osteopenia
Steroids<\/p>\n\n\n\n
Which of the following about pancreatic enzymes is true?
We give these for statarea (fat in stools).<\/p>\n\n\n\n
What other medical states can trigger the need for pancreatic enzymes?
Bariatric procedures<\/p>\n\n\n\n
Prescribing a pancreatic enzyme replacement (Lipase, Proease, Amylase)
Prescribing for units of Lipase<\/p>\n\n\n\n
Metronidazole bacterial vaginosis, patient drinks.
Tell patient not to drink<\/p>\n\n\n\n
Do the gell instead<\/p>\n\n\n\n
Or clindamycin<\/p>\n\n\n\n
Take their SOCIAL hx<\/p>\n\n\n\n
Why NP need prescriptive authority
Access to care<\/p>\n\n\n\n
Prescribing drug with narrow therapeutic index
Do labs frequently<\/p>\n\n\n\n
Patient brings in x tablets and y tablets – same drug, different brands
The inactive ingredients can be different<\/p>\n\n\n\n
Cause rates of dissolution to be different (dissolve differently)<\/p>\n\n\n\n
IV gentamicin, labs show toxic levels, on normal dose
Gentamicin highly bound to serum albumin – check if patient is taking other medications that are binding to serum albumin.<\/p>\n\n\n\n
When you write a prescription what does it need?
Sig (directions)
Drug
Dose
Frequency
Route
Refills<\/p>\n\n\n\n
ie. given – Lasix, 20mg, PO, daily<\/p>\n\n\n\n
Narcotic analgesic for chronic pain, patient is taking more than prescription, patient is alert, oriented and VSS. What’s going on?
Tolerance<\/p>\n\n\n\n
When is the highest risk for teratogenic risk in pregnancy
First trimester<\/p>\n\n\n\n
5 year old has gray teeth
Tetracycline<\/p>\n\n\n\n
Older adult, routine visit, on highly protein bound drug (like warfarin), what are you concerned about?
Serum albumin level<\/p>\n\n\n\n
Son here, concerned, father had total hip, in pain, son is adamant that he gets demerol (meperidine) what do you tell him
Education and morphine<\/p>\n\n\n\n
Patient is wheezing, SOB, hr 80, resp 24, 124\/78, provider orders nonselective beta agonist medication. What side effect of that is a primary concern?
Tachycardia<\/p>\n\n\n\n
What do we use pilocarpine for?
Lowers intraocular pressure in patients with glaucoma.<\/p>\n\n\n\n
A provider reviews a patient’s chart before using bethanechol for post op urinary retention. Which is contraindicated in using this treatment?
Stimulates cholinergic receptors, asthma patients take anticholinergic drugs. Can cause bronchoconstriction<\/p>\n\n\n\n
Medication for seasickness
Scopalopine<\/p>\n\n\n\n
S\/E of cyclobenzaprine (10mg a day – big dose)
Blurred vision
Dry mouth
Constipation<\/p>\n\n\n\n
Patient with seizures, place on antiepileptic drug, seizures aren’t getting better
Check the levels<\/p>\n\n\n\n
Phenytoin for seizures, want an oral contraceptive, what would you tell them
Consider different form of hormone<\/p>\n\n\n\n
You do not prescribe these together, you will prescribe something a non oral contraceptive medication instead<\/p>\n\n\n\n
Is it ok for patients in their third trimester to take ASA
No – closes ductus arteriosus<\/p>\n\n\n\n
Prescribing prednisone for tendonitis, patient says they are being treated for valley fever- do we still prescribe?
No – increases immunocompromised<\/p>\n\n\n\n
Select all. 11 yo has all vaccines, wellness check, do they need their:
Hep B NO
PCV 23 NO
TDap YES
MCV4 YES
HPV YES<\/p>\n\n\n\n
What is one of the reason we start methotrexate early in RA
Reduces damage<\/p>\n\n\n\n
Patient with gout while taking NSAID for a couple months – gonna start privenicine, but now they have an acute gout outbreak. Do we start privenicine?
Delay privenicine (not for acute gout)<\/p>\n\n\n\n
Patients with elevated uric acid, on warfarin, need to start allopurinol – what do you need to do with the warfarin?
Need to reduce warfarin<\/p>\n\n\n\n
Patient who has had three gout flare ups in the last year. What kind of medication do we give?
Give urate lowering drug<\/p>\n\n\n\n
(allopurinol, febuxostat, Rasburicase)<\/p>\n\n\n\n
(canagliflozin, losartan, fenofibrate and sevelamer)<\/p>\n\n\n\n
Paget’s disease – bone pain- what medication really helps?
Calcitonin<\/p>\n\n\n\n
Alendronate (for post menopause osteo) – what do you tell your patients?
Sit up for 30 minutes, take with full glass of water<\/p>\n\n\n\n
Phenylephrine nose spray – taking way too much – what’s gonna happen?
Nasal spray addiction – what do we do? Intranasal steroids.<\/p>\n\n\n\n
Patient with cough, advised to use guaifenesin, they ask why?
It stimulates the flow of secretions so they are easier to cough up. It is an expectorant.<\/p>\n\n\n\n
Step one management for asthma
Short acting beta agonist (answers look weird)<\/p>\n\n\n\n
Do we give magnesium hydroxide in renal failure?
No, because they can not capitalize the magnesium and can end up with torsades.<\/p>\n\n\n\n
Post op patient taking opioid meds after ORIF, what meds would we use to prevent constipation
Colace<\/p>\n\n\n\n
Chronic alcoholic, cirrhosis, elevated ammonia level. What medication are they going to get?
Lactulose<\/p>\n\n\n\n
Chemo induced N\/V, zofran isn’t working as well, what do you add?
Dethamexazone<\/p>\n\n\n\n
Cholesterol therapies causes flushing
Niacin<\/p>\n\n\n\n
Immigrant is thin and malnourished, sores, bruises, bleeding gums, gingivitis, missing teeth, what vitamin deficiency?
Vitamin C (Ascorbic Acid)<\/p>\n\n\n\n
Alcoholic, ataxia, double vision and confusion, evaluate them and they have nystagmus, what vitamin are they deficient in?
Thiamine<\/p>\n\n\n\n
Phentermine and topiramate for weight loss
Topiramate – feelings of satiety<\/p>\n\n\n\n
St. john’s wort
Accelerate the metabolism of many drugs (SSRIs)<\/p>\n\n\n\n
Inform other providers about this medication to ensure SE or stop the medication<\/p>\n\n\n\n
COPD develops bronchitis, 39.5 fever
ABX and sputum culture<\/p>\n\n\n\n
Child with ear infection – treated with amoxicillin, what do you move to?
Augmentin<\/p>\n\n\n\n
Pseudomonas infection on piperacillin (zosyn), blood urea nitrogen and serum cr are elevated, what do you do?
Decrease dose<\/p>\n\n\n\n
What cephalosporin treats MRSA?
Ceftaroline<\/p>\n\n\n\n
What do we treat CDiff with?
Oral Vanco<\/p>\n\n\n\n
With clindamycin
if they develop bad diarrhea, you may stop it.<\/p>\n\n\n\n
Patient receives the first dose of azithromycin 500mg at 8 today, when should the second dose be tomorrow?
8 (24 hours later),<\/p>\n\n\n\n
Patient receiving aminoglycoside, culture shows an anaerobic organism. What do you need to do?
Change it. Aminoglycosides don’t treat anaerobes.<\/p>\n\n\n\n
Conjunctivitis, prescribe aminoglycoside, which one would you prescribe?
Neomycin<\/p>\n\n\n\n
Young, non pregnant female, UTI, what do you treat with?
Bactrim 3 days<\/p>\n\n\n\n
A one dose medication is fosfomycin<\/p>\n\n\n\n
6 yo child, tympanic membrane is red, bulging but intact. What can you do for pain?
Lidocaine drops<\/p>\n\n\n\n
18 month old, 24 hour fever, in clinic, child distraught, bulging eardrum, what ABX do you give?
Amoxicillin<\/p>\n\n\n\n
How do we treat simple, scattered comedones in adolescents before we had ABX?
Benzoyl peroxide<\/p>\n\n\n\n
14 yo female, not responding to topical drugs for acne, what would you choose?
Doxycycline<\/p>\n\n\n\n
Open angle glaucoma, prescribing timolol (beta blocker) what condition can we make worse when we prescribe this?
Asthma<\/p>\n\n\n\n
What do you give lamictal for
Seizures<\/p>\n\n\n\n
A patient is on lamictal and comes in with complaints of rash, low grade fevers, swollen lymph nodes, what does the provider need to do?
Hypersensitivity while on lamictal (the rash) can lead to multi organ dysfunction<\/p>\n\n\n\n
STOP drugf<\/p>\n\n\n\n
A patient on lamictal needs to be on oral birth control, what do you do for dosage?
You will need to INCREASE the dose of lamictal because the oral contraceptives will bring the medication levels down<\/p>\n\n\n\n
What medication class is Buspar?
SNRI<\/p>\n\n\n\n
Patient on 10mg percocet and a 10mg oxycodone but the percocet works faster why?
This occurs because the composition of the metabolism filler is different<\/p>\n\n\n\n
What do medications need in order to be effective?
Albumin (drugs need this to bind to), lab work will be important<\/p>\n\n\n\n
Which abbreviation do you not use anymore when writing prescriptions?
QD<\/p>\n\n\n\n
Carbamazepine monitoring should include all the following except:
CBC – WE DO WANT because there aer some hemolytic anemias that can occur.<\/p>\n\n\n\n
Osteoporosis screening – WE DO WANT because carbamazepine can cause osteoporosis<\/p>\n\n\n\n
Carbamazepine drug levels – WE DO WANT because carbamazepine can become toxic<\/p>\n\n\n\n
Monthly glucose – WE DO NOT NEED<\/p>\n\n\n\n
Tricyclic antidepressants should be avoided in:
Heart Failure patients because Tricyclics will increase cardiac contractility and if the patient has ischemia, this medication could kill them because it will make the ischemia worse. Will cause sudden death.<\/p>\n\n\n\n
Prior to administering albuterol for an acute asthma attack to a patient who is on digoxin, the NP understands that:
Digoxin dosage will need to be increased<\/p>\n\n\n\n
Both meds can be given together. Albuterol will increase contractility and increase heart rate. It will decrease dig levels by 16-22%<\/p>\n\n\n\n
The NP educates which patient population regarding salmeterol’s Black Box warning?
African Americans – education should be given to the AA population because they have a significantly higher rate of death when using salumeterol<\/p>\n\n\n\n
The NP believes the patient needs additional education regarding long acting beta agonist’s Black Box warning when the patient verbalizes:
I take this medication in case of an asthma attack –
LABAs are NOT a rescue drug<\/p>\n\n\n\n
Patients who take long acting beta agonists take it everyday to help prevent asthma attacks. They still need to carry a rescue inhaler.<\/p>\n\n\n\n
A 16 year old presents to the clinic for treatment of her acne. The NP prescribes which medication?
Combination antibiotic and topical<\/p>\n\n\n\n
Want severe acne\u2026 severe or moderate to severe acne.<\/p>\n\n\n\n
Minocycline, Topical retinoids, and tetracyclines can all be used to treat but COMBINATION ANTIBIOTIC AND TOPICAL WILL BE MOST EFFECTIVE>
\u2026..
Topical combination therapy, benzoyl peroxide antibiotic, or retinoid, and oral antibiotic<\/p>\n\n\n\n
What medication can the NP add with zofran to assist a patient with chemo induced nausea?
Dexamethasone (helps with early and late nausea with zofran)<\/p>\n\n\n\n
A patient’s culture and sensitivity results, the NP sees that the patient has a protozoal infection when an obligate, anaerobic bacteria is found. What would the NP prescribe?
Metronidazole is lethal to ONLY anaerobic bacteria; this is a nitroimidazole<\/p>\n\n\n\n
A 34 year old female comes to the clinic with complaints of dysuria, frequency, and urgency. What information does the NP need prior to deciding a TMT plan?
Is this an upper or lower UTI<\/p>\n\n\n\n
recent UTI (how many or what time) or other predisposing factors<\/p>\n\n\n\n
foley catheter<\/p>\n\n\n\n
pregnant?<\/p>\n\n\n\n
How long have her symptoms been going on?<\/p>\n\n\n\n
UNCOMPLICATED CAP: bactrim 3 day short course therapy to help not lead to resistant, cheaper, and compliance<\/p>\n\n\n\n
CONVENTIONAL THERAPY: 7 day course<\/p>\n\n\n\n
Which oral ABX do you prescribe for a patient with moderate acne? ANY below
Minocycline- 1st line<\/p>\n\n\n\n
Doxycycline- 1st line<\/p>\n\n\n\n
Tetracycline- allergies this is 2nd line<\/p>\n\n\n\n
Erythromycin- allergies this is 2nd line<\/p>\n\n\n\n
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