Maryville NURS 615 Pharm Exam 2 ACTUAL EXAM

Maryville NURS 615 Pharm Exam 2 ACTUAL EXAM

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• Carbamazepine (Tegretol) can sometimes show subtherapeutic range due

to what?: Carbamazepine auto-induces metabolism, leading to lower levels de-

spite good compliance

2. What are the black box warnings for Carbamazepine?: Dermatologic reac-

tions

• Steven's Johnson
• Toxic epidermal necrolysis

3. What lab test should be ordered for patients on Carbamazepine?: CBC

every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC

• What kind of teaching needs to be done with families of patients who have

seizure disorders?: Prevention is important, patient safety is important, Do NOT abruptly stop taking medication.

5. Ethosuximide (Zarontin), an anti-seizure medication can cause what?: -

Blood dyscrasias

• Patients taking Topiramate need to be monitored for what electrolyte im-

balance?: Decreased sodium bicarb leading to hyperchloremic metabolic acidosis

7. Topiramate treats seizures and what is one common side effect?: Normal

side effect is weight loss, especially in higher dose patients

8. A child on Topiramate that wants to play sports should monitor what?: -

Don't get overheated. Topiramate may affect his ability to sweat in the heat.

• What should a pregnant patient be told about taking Valproate (De-

pakote)?: It is a known teratogen and category X medication. It should not be used in the first trimester, it may be restarted in second trimester.

• What patient population should tricyclic antidepressants be used cau-

tiously in?: Heart Disease patients

• Phenelzine (Nardil) is a MAOI. What teaching needs to be done with this

medication?: He should not use serotonergic drugs like Imitrex. Also, this class of medication interacts with yogurt, sour cream, soy sauce, etc.

• Phenelzine (Nardil) may cause what if there is an interaction with known

contraindicated foods?: Hypertensive crisis

• What are the side effects of tricyclic antidepressants?: Anticholinergic type

effects like dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, mania

14. How long does it take for SSRIs to t effect: 2-6 weeks

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Maryville NURS 615 Pharm Exam 2

15. SSRIs may cause what onset of action symptoms?: Nausea, but this will

usually resolve in a week.

16. What is one thing you should not do with SSRIs?: Drink alcohol

17. What should happen when going off an SSRI?: Wean slowly, do not stop

abruptly

• What medications would a patient with depression and anxiety respond

well to?: Buspar and an SSRI combined

Celexa (Citalopram) Lexapro (Escitalopram)

19. Why should you combine an SSRI with Buspar?: Buspar augments the

SSRI and is a good combo for anxiety and depression

• What is a first line drug for mild to moderate generalized anxiety disor-

der?: Buspirone

21. How fast does Celexa start to demonstrate effects?: Improved appetitie

and concentration in 1-2 weeks.

22. What is a major drug to treat bipolar disease?: Lithium

23. Blood levels need to be monitored with Lithium because why?: Lithium

has a narrow therapeutic range so it is important to recognize toxicity

24. What are symptoms of lithium toxicity?: Drowsiness and Nausea

25. What dietary teaching needs to be done with patients taking lithium?: Salt

intake needs to be consistent

• What are the side effects of SSRIs (selective seratonin reuptake in-

hibitor)?: N/V, dizziness, light headedness, dry mouth, increased sweating, weight changes, agitation, sexual side effects.

• What are the side effects of SNRIs (serotonin norepinephrine reuptake

inhibitor): Headache, somnolence, dizziness, insomnia, nervousness, dry mouth,

constipation, abnormal ejaculation, anorexia/weight loss, elevated BP

• What are the side effects of MAOIs?: Insomnia, anxiety, agitation, dizziness,

headache, restlessness, hypotension, dry mouth, blurred vision, constipation

29. What Benzo has the greatest likelihood of dependence?: Xanax /alprazo-

lam

30. What receptors do Benzos act on?: Enhances the neurotransmitter GABA

(gamma-aminobutyric acid) receptors

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31. What result do Benzos have on the body?: sedative

hypnotic anxiolytic anticonvulsant muscle relaxer

32. What are long acting Benzos prescribed for?: Treatment of anxiety

33. What are short acting Benzos prescribed for?: Treatment of insomnia

34. What would be a good medication to prescribe for panic disorder?: Di-

azepam (Valium)

35. What is a anorexiant medication to treat obesity?: Phentermine

36. What is a precaution with Phentermine?: Anorexiants may cause tolerance

and should only be used for 6 months

• What medications or herbals should be avoided with Phentermine?

Why?: SSRIs and St. Johns Wort...the combination may cause serotonin syn-

drome

38. Phentermine releases what two chemicals?: Epinephrine and norepineph-

rine

39. Epi and norepi causes what to break down?: Fat cells to break down stored

fat

40. What are Signs and symptoms of seratonin syndrome?: Headache, agita-

tion, mental confusion, hallucinations, coma

• What are autonomic effects that you can get from seratonin syndrome?-

: Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diar- rhea

• What factors place a patient at risk for developing antimicrobial resistant

organisms?: Inappropriate use of antibiotics

Children less than 2 years of age Adults older than 65 yrs of age Patients who do not finish their antibiotic regimen

• What are appropriate antibiotics to prescribe to pregnant women and

children?: PCN or Cephalosporins

(Amoxicillin, or Augmentin)

44. Which antibiotics inhibit cell wall synthesis?: Beta-lactam antibiotics

Vancomycin

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45. Why is clavulanate added to Amoxicillin?: Clavulanate is a Beta-lactam

inhibitor. This increases the spectrum of action and is effective at preventing amoxicillin-resistant bacteria that produce Beta-lactamase

• What type of antibiotics should be avoided in children and pregnant

women?: Tetracycline, fluoroquinolones

47. What is a normal side effect of amoxicillin?: Diarrhea and it is recommend-

ed to continue to take the medicine, drink lots of water, and take probiotics daily, eat yogurt

• The American Heart Association recommedations for prophylaxis an-

tibiotic use prior to dental care are...: 1. Prosthetic cardiac valve or prosthetic material used in valve repair

• Previous Endocarditis
• The following congenital diseases
• Unrepaired cyanotic congenital heart disease including palliative shunts and

conduits II. Completely repaired congenital heart disease with prosthetic material device, whether placed surgically or with a catheter for 6 months following the procedure III. Repaired congenital heart disease with residual effects at the site or adjacent to the site of a prosthetic patch or prosthetic device which inhibit endothelialization IV. Cardiac transplantation recipients with cardiac valvular disease

49. What antibiotic is used for dental appointments?: Amoxicillin 2 gm for

adults 50mg/kg in children

50. What should fluoroquinolones be reserved to treat?: Community acquired

pneumonia in patients with comorbidities and Hospital acquired pneumonia

51. What is the black box warning for fluoroquinolones?: It may cause tendon

ruptures. Specifically of the achilles tendon.

52. What medication can be affected with the use of fluoroquinolones?: War-

farin because fluoroquinolones displace the flora of the gut and displaces warfarin from albumin and interferes with metabolism by the P450 system.

• Why are tetracyclines not recommended in pregnancy and in children

less than 8 yrs of age?: They can cause staining of teeth, and cause problems

with bone growth.

• What population can tetracyclines like minocycline be used on? And pa-

tients who use it might develop what?: Adolescents. It may cause psuedotumor

cerebri, drug-induced lupus and hepatitis, skin photosensitivity, tinnitus, fatty liver

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