NUR 635 Advanced Pharmacology Final
A patient received 500 mg of azithromycin [Zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin?
250 mg at 0800 the next day
Adults with pneumonia responding to antimicrobial therapy should show improvement response in?
48-72 hours
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]
Providers should use an for prescribing?
A chart of local resistance patterns developed by labs
A pt has had 3 gout flareups in past year what do you prescribe?
A uric lowering drug
Tetracyclines such as minocyclines are safe to use in?
Adolescents
Sarah a 42 year old female requests medication for anorexia to treat her obesity? Phentermine
Anorexians may cause tolerance and only prescribed for 6 months
A pregnant pt in her 3rd trimester asks the nurse if she can take aspirin for headaches?
Aspirin causes premature closure of ductus arteriosus, don't take
Janet was recently treated with clindamycin for an infection, calls due to diarrhea with blood?
Asses her for pseudomembranous colitis
Nicole is a 16 year old taking minocycline for acne and comes in with a headache? What is the plan of care?
Assess for Pseudotumor Cerebri (idiopathic increased intracranial pressure)
Patient prescribed gabapentin for neuropathic pain, pt complains of depression and suicidal thoughts?
Assess for suicidal ideation
A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition?
Asthma
A child with an ear infection did not respond to amoxicillin. What is the next line of tx?
Augmentin
An adolescent has recently scattered comedones across forehead and nose, which medication does the provider recommend to pt and parents?
Benzoyl peroxide
Patients with pheochromocytoma should avoid which class of drugs that could cause HTN crisis?
Beta 2 agonists.
Education for pt's who used inhaled beta agonist and inhaled corticosteroid, which order to use?
Beta agonist first and then corticosteroid
A young patient with low back injury has muscle spasms, cyclobenzaprine, which teaching?
Blurred vision, dry mouth, constipation
There is often cross-sensitivity between penicillins and cephalosporins?
Both drug classes beta lactamase ring sensitive to beta lactamase producing organisms
An appropriate first line drug to try for mild-moderate generalized anxiety disorder?
Buspirone
A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient?
Ceftaroline
When writing out a prescription do you write daily or Qday?
Daily
A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order?
Doxycycline (Vibramycin) and tretinoin (Retin-A)
David presents to the clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes:
He should not wear his soft contacts while using the cromolyn eye drops.
Conjunctivitis in a pt that is accompanied by acute otitis media is treated with?
High dose oral amoxicillin
Which of these factors puts a patient at risk of developing antimicrobial resistance?
Inappropriate use of antimicrobials
Pt uses st johns wart. Why is this concerning?
It can accelerate metabolism of some drugs
A 6-year-old child presents with crying due to ear pain. Tympanic membranes are erythematous, bulging, and immobile, but intact. In addition to antibiotic therapy, what will the provider recommend for pain management?
Lidocaine ear drops
A patient shows signs and symptoms of conjunctivitis. Which amino-glycoside would the nurse expect to be ordered?
Neomycin [Neomycin]
Chantix may be prescribed for tobacco cessation, education includes?
Neuropsychiatric symptoms may occur
A pt who uses nutritional therapy who manages a cholesterol level reports flushing?
Niacin
When prescribing metronidazole for bacterial vaginosis, education includes?
No alcohol consumption
Methylnaltrexone or relistor is used to treat constipation in patients with:
Opioid induced constipation
Ciprofloxacin otic drops are contraindicated in a patient with?
Perforated tympanic membrane
An 18-month-old child with a 24-hour history of fever and otalgia is seen in the clinic. The child's parents tell the provider that the child was inconsolable during the night. The provider examines the child and notes a bulging, immobile, erythematous tympanic membrane. What action will the provider take to provide the child with effective care?
Prescribe amoxicillin at 45 mg/kg/dose twice daily.
Which new diagnosis will prompt the provider to discontinue PRN order for magnesium hydroxide?
Renal failure
A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?
Request an order for a different class of antibiotic.
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?
Request an order to administer dexamethasone with the ondansetron.
A pt is given new diagnosis of RA, basis for methotrexate?
Starting early can delay joint degeneration
What does the carbamazepine black box warning refer to?
Stevens Johnsons syndrome and toxic epidermal necrolysis
A pt with a cough has been advised to use guaifenesin, the patient asks why, what response will you provide?
Stimulates flow of secretions so easier to cough up
Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because:
The additive effects may include bradycardia.
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
The patient should stop taking the clindamycin now and contact the provider immediately.
Before prescribing Phentermine, drug history, make sure you look for SSRIs and st john's wort due to the risk of?
The risk for serotonin syndrome
A pt who recently immigrated from a 3rd world country, presents with gingivitis, missing teeth, and bleeding gums. What's the likely cause?
Vit C Deficiency
An elderly patient comes in with a nail fungal infection what is the course of treatment?
Weigh out if hepatic and renal injury is a risk due to prolonged therapy requirements
A pt taking anti-epileptic drug reports no change in seizure activity?
Write an order for serum drug levels
IV gentamicin, has a toxic drug level, which possible cause of this situation will the provider explore?
assess whether the patient is taking a medication that binds to serum albumin. (Gentamicin binds weakly to plasma proteins, so another drug could cause it to not be able to bind.)
First-line therapy for a patient with acute otitis externa (swimmer's ear) and an intact tympanic membrane includes:
ciprofloxacin and hydrocortisone drops.
A patient report that brand x tablets work faster than brand y tablets:
inactive ingredients used in the composition may cause different rates of dissolution which can alter the onset of action of the drug.
A patient is being prescribed acyclovir what education should the provider include?
increased fluid intake
A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:
reducing the dose of piperacillin.
18 y.o. patient diagnosed with frequent migraines, what Is abortive therapy for migraines?
triptans- (ABORTIVE MEDS FOR MIGRAINES)
Monitoring for pt's on long-term antifungal therapy with ketoconazole?
AST, ALT, alkaline phosphatase, bilirubin
A provider review's pt's chart before prescribing bethanechol which pre-existing condition is of caution?
Asthma
Patient recently started on carbamazepine for seizures, he comes in and his levels are sub-therapeutic?
Auto-metabolism, need to switch to a new agent.
First line tx of community acquired PNA?
Azithromycin
Which antibiotic regimen is most appropriate in treating CAP in an adult with comorbidities?
Azithromycin plus ceftriaxone
Sally 16yr old female has a UTI and has not used any other antibiotics within the last 6 months what is the course of tx?
Bactrim (sulfamethoxazole/trimethoprim)
Which of the following agents is considered first line therapy for soft tissue infections like MRSA?
Bactrim (sulfamethoxazole/trimethoprim)
A step-wise approach to pharmacological management of asthma?
Begins determining severity of asthma and assessing asthma control
Pt's with COPD require monitoring of?
Beta 2 agonist use
To prevent development, or further of antibacterial resistance, fluoroquinolones reserved for?
CAP in pt's with comorbidities
Pt prescribed topiramate for weight loss. What is the function of this medication?
Causes feeling of satiety
Long term monitoring of patients taking carbamazepine includes:
Complete blood counts every 3-4 months.
A pt being treated with warfarin develops hyperuricemia?
Discuss reducing warfarin dose with the patient
You have an older adult pt with opioid after ORIF which med do u prescribe to prevent constipation?
Docusate
Which of the following statements about pancreatic enzymes is true?
Dosing may be titrated according to the decrease of steatorrhea
Elderly patient prescribed lactulose for chronic constipation, monitoring includes?
Electrolytes including potassium and chloride
An appropriate drug for treatment of depression with anxiety?
Escitalopram (lexapro)
GERD is aggravated by?
Estrogen lowers esophageal sphincter tone
A provider speaking to a class or group of patients, which trimester has most teratogenic effects?
First
Which of the following meds is most appropriate for pt. with neuropathic pain?
Gabapentin
Prophylactic use of bisphosphonates is recommended with patients with early osteopenia due to long term use of which drugs?
Glucocorticoids
Why is the consistency of taking paroxetine and not running out of medication than with other SSRIs?
Has a shorter half-life and shorter withdrawal window when not tapered
Prior to starting antidepressants pt's should have labs to rule out?
Hypothyroidism
A 21yr has gonococcal conjunctivitis. What is the tx choice?
IM ceftriaxone
A pt with severe alcohol use disorder ataxia, double vision, nystagmus, which vitamin?
IV thiamine
Is the key to prevention of osteoporosis, which is false?
If exercise is incorporated into regular activity vitamin d and calcium are not needed (vitamin d and calcium supplements are still needed)
The tricyclic antidepressants should be prescribed in caution for?
In pt's with heart disease
Carbamazepine has a black box warning recommending testing for the HLAB1502 allele with Asian ancestry prior to starting therapy due to?
Increased risk for Stevens Johnson's syndrome
Long acting beta agonist received black box warning due to?
Increased risk of asthma related deaths when LABAs are used
Metoclopramide improves GERD by?
Increasing lower esophageal tone
Pt with a cold that uses phenylephrine spray, since then its become impossible because congestion increased?
Intranasal glucocorticoid while phenylephrine is withdrawn
Pt's who are on chronic long term PPI require monitoring for?
Iron, B12, calcium deficiency
A pt. with history of chronic alcohol use admitted with diagnosis of cirrhosis, ammonia is elevated, what med?
Lactulose
First-line antibiotic choice with comorbidities who is immunosuppressed and has pneumonia can be treated outpatient as?
Levofloxacin (respiratory fluoroquinolone)
Patients with CF are often prescribed enzyme replacement for pancreatic is dosed in units of?
Lipase
First line therapy for mild persistent asthma?
Low dose inhaled corticosteroids
A provider is reviewing elderly patient's chart, which is of greatest concern in renewing prescription for highly bound protein drugs?
Low serum albumin
Prior to developing plan for treatment of asthma, according to guidelines, in adults
Mild to Moderate is more than twice a week and not more than once a day
A patient being prescribed phenytoin for seizures, what does monitoring include?
Monitor for phenytoin syndrome, 3-5 weeks after starting therapy
When prescribing drugs with a narrow therapeutic range:
Monitor patients plasma drug levels at regular intervals.
What would be the first line med for mild-moderate pain, sprained ankle?
NSAID (Ibuprofen)
85yr old patient with shingles is miserable with pain and discomfort what is the tx plan?
NSAIDs, Acyclovir, topical lidoderm once lesions resolve
You have an older adult pt with hx of COPD, developed bronchitis, temperature of 39.5, what action will you take?
Order empiric antibiotic while waiting for sputum culture results
Pt. diagnosed with cluster headaches, what would the appropriate acute therapy be?
Oxygen 100% for 15-30 minutes
TX for a patient with GERD step down approach is
PPI
First line tx for a peptic ulcer+H.Pylori?
PPI+Amoxicillin+clarithromycin
Pt's who are at risk for fatal asthma attack includes pt's who?
Patients with Hx of needed intubation or ICU admission
An older patient is entering the immediate postoperative period after total hip replacement, son asks for Demerol, what action will the provider take to address pain?
Prescribe morphine and discuss rationale with pt's son
Your pt experiences acute gouty episode despite taking NSAIDs, plan for probenecid, acute episode can cause?
Probenecid will be delayed until acute episode subsides
What is an appropriate drug for the treatment of migraine headaches in an 18-year-old?
Propranolol aka inderal
A pt is prescribed metronidazole, which is concerning?
Pt drinks 2 glasses of wine every night
Many patients self medicate with antacids, which pt should be educated to not take tums?
Pt's with kidney stones
Your pt has been on Lexapro for a year willing to be tapered off SSRI, initial dosage adjustment?
Reduce by 50% for 3 to 4 days
Pt. taking Lamictal for seizures, she requests a prescription for a combined oral contraceptive that reacts with Lamictal, what would happen?
Reduced lamotrigine levels requiring double the dose of lamotrigine.
Suzanne is started on paroxetine (paxil) an SSRI for depression, info regarding antidepressant includes?
SSRIs may take 2-6 weeks for max effect
What medication will you prescribe as step 1 in asthma patient?
Short acting beta 2 agonist
Treatment for mild intermittent asthma is?
Short acting beta 2 agonist (albuterol PRN)
Besides CF which other medical state will need pancreatic enzymes?
Some bariatric surgeries
Pt's with COPD exacerbation may require?
Systemic corticosteroid burst
A provider is about to prescribe prednisone for tendonitis, which item would cause you to reconsider action?
Systemic fungal infection
A pt is wheezing and SOB HR 88, BP 124/78, non-selective beta agonist, beside eval for pt's resp distress which side effect watch out for?
Tachycardia
Alendronate is prescribed for a post menopausal women. What education would you give to the patient?
Take with plenty of water and remain upright for 30 minutes
An 11 year old boy received all childhood immunizations before kindergarten, which vaccines at current age would you recommend?
Tdap, meningococcal, and HPV
A five-year-old has gray teeth, provider asks about which meds?
Tetracyclines
A 59 year old post menopausal woman with hx of breast cancer at 40 years?
Topical conjugated estrogen cream
Treatment choice for a patient with genital herpes?
Valacyclovir
A pt with severe Paget's disease of the bone asks provider what can be done to alleviate pain?
calcitonin salmon
82yr patient has shingles and will get Valacyclovir. What should be assessed prior to starting tx?
renal function
Jamie has glucose 6 phosphate dehydrogenase deficiency, which antibiotic class should we avoid in this patient?
sulfonamides
Fluroquinolones have black box warning for ______ even months after treatment
tendon rupture