Pharm Exam 3

tetracyclines

inhibition of ribosomal protein synthesis

cephalosporins

inhibition of cell wall synthesis

After 3 doses of the antibiotic, Mr. Rizzo's blood urea nitrogen (BUN) and creatinine levels are elevated. The physician changes the antibiotic to avoid potential renal failure. Which of the following medications, if prescribed, would not contribute to causing renal impairment? 1. Ciprofloxacin (Fluoroquinolones) 2. Gentamycin (Aminoglycosides) 3. Amphotericin B (Polyene Antifungal)

1. Ciprfloxacin (Fluoroquinolones)

Order the six steps of the asthma treatment algorithm

1. inhaled short-acting beta adrenergic agonists 2. low dose inhaled corticosteroids 3. low dose inhaled corticosteroid and long-acting beta agonist 4. medium dose inhaled corticosteroid and long-acting beta agonist 5. high dose inhaled corticosteroid and long-acting beta agonist 6. high dose inhaled corticosteroid, long-acting beta agonist, and oral corticosteroid

Match the drug in the left column to the action in the right column. 1. Clopidogrel (Plavix) a. injectable med that dissolves blood clots 2. Alteplase (Activase) b. injection given to prevent/treat DVT or pulmonary embolus 3. Enoxaparin (Lovenox) c. oral med inhibits platelet aggregation

1= c 2= a 3= b

After several days of antibiotic administration, Mr. Rizzo continues to have an elevated temperature and white blood cell count, and he complains of chills and a stiff neck. It is determined that the meningococcal organism has become resistant to the antibiotic he was receiving. Which of the following factors does not contribute to the development of microbial resistance within a community? 1. animal production 2. antimicrobial soaps 3. fungal spores 4. incorrect use of antibiotics by individuals

3. fungal spores

Because the patient is allergic to penicillin, which of the following medications is appropriate to prescribe for the bacterial meningitis? 1. Cephalexin (Keflex) 2. Amoxicillin (Amoxil) 3. Isoniazid and Rifampin 4. Vancomycin

4. Vancomycin

What nursing assessments/adverse reactions will you consider as you administer each medication? Albuterol = Vancomycin= Tylenol = Cethromycin =

Albuterol = CNS stimulation, muscle tremors, careful in CV disease and elderly Vancomycin= hypersensitivity, thrombophlebitis, ototoxicity, nephrotoxicity, red man's syndrome Tylenol = liver enzymes Cethromycin = GI upset

This drug causes irreversible acetylation of cyclooxygenase which inhibits platelet aggregation and prolongs bleeding time.

Aspirin

This drug is an HMG-CoA Reductase Inhibitor which decreases cholesterol synthesis in the liver. The major adverse effects include muscle/joint pain and, in severe cases, rhabdomyolysis

Atorvastatin

This antiplatelet drug inhibits platelet aggregation and can be used to prevent blockage of coronary artery stents. It is also used to prevent MI and stroke in patients with acute coronary syndrome

Clopidogrel

Mr. Rizzo has steady improvement after his antibiotic therapy but he develops 2 suprainfections. One is persistant infectious diarrhea which is diagnosed as CDifficile and the other infection is an oral infection which is determined to be thrush. What medications would you anticipate would be prescribed for Mr. Rizzo for each of these infections?

Diarrhea- Metronidazole (Flagyl)Thrush- Nystatin

This classification of oral agents selectively inhibit factor Xa. Dose titration and blood level monitoring is not necessary. There is no reversal agent.

Direct Factor Xa Inhibitors

IV drugs in this classification of drugs inhibit thrombin without interacting with antithrombin and are generally used in coronary angioplasty and cardiopulmonary bypass in those who are unable to tolerate heparin. The oral (PO) drugs in this classification can be used in place of warfarin to prevent embolism in non-valvular atrial fibrillation. No therapeutic drug monitoring is required, reversal treatment is available, and there are lower bleeding rates compared with warfarin.

Direct Thrombin Inhibitors

is the name of the drug which caused the death of more than 100 people in 1938, resulting in the enactment of the Food, Drug, and Cosmetic Act

Elixir sulfanilamide

Drug resistance is more likely to occur with narrow spectrum antibiotics rather than broad spectrum antibiotics

False

True or False: Rhabdomyolysis is a serious adverse reaction which can be caused by PCSK9 Inhibitors

False

This classification of agents, also called clot busters, are administered by IV or intra-arterial routes within 3 hours of an acute ischemic stroke or six hours of an acute myocardial infarction to dissolve the clot and reestablish blood flow.

Fibrinolytics

An overdose of this drug which is a daily dosed synthetic LMW heparin derivative cannot be treated with protamine sulfate. This synthetic pentasaccharide anticoagulant inhibits factor Xa but not thrombin.

Fondaparinux

An adverse effect of this drug is called HIT and is characterized by a dangerous decrease in the platelet count. It can be administered by the IV or Sub-Q routes. It is prescribed in units rather than milligrams and is titrated based on lab monitoring of aPTT/PTT.

Heparin (unfractionated)

This drug is an injection that can be self-administered in the home. It can be given on a fixed dose without the need for routine monitoring of coagulation or in the hospital setting, it may be adjusted by weight.

Lovenox (LMW heparin)

This classification of drugs, sometimes called super aspirins, are administered IV, and cause reversible blockade of platelet GP IIb/IIIa receptors. They are indicated short-term in acute coronary syndrome and coronary angioplasty and are frequently given in conjunction with aspirin and heparin.

Platelet Glycoprotein IIb/IIIa receptor blockers

True or false: First and second generation cephalosporins are ineffective in treating meningitis because they have a poor ability to cross the blood-brain-barrier (BBB) and reach the cerebrospinal fluid (CSF).

True

This anticoagulant drug can cause interactions when taking many other drugs, especially those metabolized by CYP 450. Foods rich in Vitamin K decrease the drugs effectiveness. It works by reducing production of vitamin K dependent clotting factors and is FDA pregnancy Risk Category X. It can take 3 days to reach its peak effect. Once in the blood, about 99% of this drug is bound to albumin. Lab monitoring with INR is used to monitor this drug. An INR of 2 to 3 is appropriate for most patients taking this drug, although for some patients the target INR is 3 to 4.5. The antidote for overdose is Vitamin K.

Warfarin

The health care provider decides to send Mr. Rizzo home on oral Metronidazole. Mr. Rizzo has a history of alcoholism and so the nurse cautions him against the use of alcohol while taking the medication because it can cause nausea, severe vomiting, headache, weakness, and hypotension. This is called a ____reaction.

disulfiram

While the patient is still receiving continuous IV heparin, the provider prescribes oral warfarin (Coumadin). This is because a. warfarin takes 3 to 5 days to achieve therapeutic effects. b. IV heparin alone becomes ineffective after the first 1 to 2 days. c. abrupt cessation of heparin therapy increases the risk for thrombocytopenia d. warfarin reduces the risk for hemorrhage

a

Carrie tells you that that her eighteen-year-old daughter had childhood asthma, which she outgrew. She says her daughter took Montelukast (Singulair) as a child and she asks if you can tell her some more about that medication. Which of the following is true regarding montelukast (select all that apply) a. Montelukast is a leukotriene modifier (it blocks leukotriene receptors) b. Montelukast can be used as a rescue medication to treat an acute asthma attack c. Montelukast causes bronchodilation and reduces airway inflammation d. Montelukast is administered via metered-dose-inhaler (MDI)

a ,c

sulfonamides

inhibition of folic acid synthesis

fluoroquinolones

inhibition of nucleic acid or DNA synthesis

Carrie says she has seen television advertisements for Advair and she wants to know more about it. Which of the following statements are true regarding Advair (select all that apply)? a. Advair is an inhaled medication b. Advair can be used as a rescue medication during an acute asthma attack c. Advair is a combination corticosteroid (glucocorticoid type) and long acting beta 2 adrenergic agonist d. Advair acts by blocking H2 receptors in the lungs

a, c

During a history and physical, Carrie tells the provider that she has seasonal allergies. The provider prescribes Cetirizine (Zyrtec) as an antihistamine for the allergies when she is ready to be discharged. The drug is an antimuscarinic. What are important teaching points for Carrie related to this medication? (select all that apply) a. adverse effects may include dry mouth, blurred vision, and urinary retention. b. oral fluids should be restricted to minimize the drug's adverse effects. c. use of antihistamines in children may result in CNS stimulation with nervousness and tremors. d. the drug should be administered prophylactically during allergy seasons.

a, c, d

The provider discharges the patient to home with a prescription for warfarin (Coumadin). You should advise the patient to do which of the following? (Select all that apply) a. Avoid taking NSAIDS b. Use a disposable razor c. Brush his teeth with a soft toothbrush d. Increase intake of dark green, leafy vegetables. e. Check bowel movements for signs of bleeding. f. Ask the provider before taking over-the-counter drugs.

a, c, e, f,

This anti-viral can be administered orally, IV, and topically and is safe during pregnancy. It is effective against herpes virus which includes herpes simplex (oral), genital herpes, and chicken pox (varicella)

acyclovir

This is a short-acting beta-agonist which can be used for acute attacks of asthma and other respiratory conditions. The drug can cause tachycardia, angina, and anxiety

albuterol

Carrie Westerberg is a 55 y/o female arriving in the emergency department with extreme dyspnea. Her oxygen saturation on admission is 86%, her temp. is 101 degrees orally, pulse is 124 beats per minute, her respirations are 36 breaths per minute, and her BP is 138/88. Her lung fields have expiratory wheezes. Her nailbeds are cyanotic and capillary refill is > 3 seconds. She has had complaints of increasing dyspnea over the past month. The provider prescribes a short acting beta agonist by nebulizer treatment and oxygen to be administered at 2 liters/minute. The provider also orders a chest x-ray and blood cultures to be obtained. Carrie is diagnosed with having bilateral pneumonia. Her cultures are pending. She is admitted to the medical-surgical floor for further care. 1. What medications would you anticipate would be prescribed for Carrie? Name at least 4.

albuterol vancomycin Tylenol cethromycin

This drug is an antiviral used in the treatment of Influenza A and B. It blocks the virus from uncoating and releasing new virus.

amantadine

Which of the following is an oral direct factor Xa inhibitor?

apixaban

Larry Melaney, age 65 years came into the clinic complaining of left calf pain and difficulty walking following a long ride in a vehicle. The nurse practitioner notes that the leg is red and swollen, warm to touch and it measures 40 cm on the left calf (34 on the right). Deep vein thrombosis is confirmed by doppler. Larry was started on IV heparin to prevent the clot from getting any bigger. 1. Which of the following parameters should you monitor for in regard to determining if a therapeutic dose is being administered? a. INR, 2 to 3 times the patient's baseline b. PTT, 2 to 3 times the patient's baseline c. Platelet count of 100,000 mm3 d. PT 11-12.5 sec

b

Had Mr. Rizzo not had a history of an anaphylactic type reaction to penicillin, as evidenced by his report of hives and difficulty breathing, which would have been the drug of choice to treat his meningitis? a. Cefazolin b. Ceftazidime c. Cefuroxime d. Cephalexin

b. Ceftazidime

Carrie is also prescribed a first-generation antihistamine, diphenhydramine (Benadryl) upon discharge. The most common adverse effect associated with the drug is a. muscle aches b. sedation c. anxiety d. insomnia

b. sedation

The most significant difference between a medication which is bacteriostatic versus bactericidal is ______

bacteriostatic slows bacterial growth

All of the following are true about heparin therapy except: (select all that are incorrect) a. it has a rapid onset to prevent DVT and PE. b. it doesn't cross the placenta so it can be used in pregnancy. c. it can cause minor bleeding but no major bleeding. d. it can cause heparin-induced neutropenia.

c, d

Short Acting Beta Agonists should be used with caution in patients with cardiovascular disease and the elderly. Identify 3 reasons why they may contraindicated in these populations.

can worsen or cause tachycardia, palpitations, angina, and hypertension (B1 effect)

This drug is a bile acid-binding resin taken before meals to accelerate the excretion of bile acids. GI symptoms and decreased absorption of some vitamins are the adverse effects

cholestyramine

Which of the following antilipid medications prevents reabsorption of bile acids by binding to them in the intestine so they can be excreted?

cholestyramine

Several months later, Mr. Melaney's doctor decides that Larry should be changed from warfarin to apixaban. Which of the following is NOT an advantage for Mr. Melaney in switching to the new drug? a. no coagulation labs (INR) need to be monitored due to a predictable dose being prescribed. b. Vitamin K is no longer a concern with daily dietary intake. c. studies have shown that there is less major bleeding and fewer drug interactions. d. the antidote for apixaban is protamine sulfate.

d

Which of the following drugs should you have ready in case of heparin overdose? a. aminocaproic acid (Amicar) b. deferoxamine (Desferal) c. vitamin K d. protamine sulfate

d

metronidazole

inhibition of nucleic acid or DNA synthesis

aminogyclosides

inhibition of ribosomal protein synthesis

Which anticoagulant is used to treat ischemic stroke?

fibrinolytic agents

vancomycin

inhibition of cell wall synthesis

This tuberculocidal agent is the least expensive drug for TB treatment, is safe for use during pregnancy, and is often used with another agent. MDR TB and XDR TB include resistance to this medication

isoniazide (INH)

This antihistamine is used to treat seasonal allergies and itching. It can cause antimuscarinic effects such as dry mouth, blurred vision, and urinary retention, as well as dizziness, confusion, and fatigue in the elderly

loratadine

Carbapenems are broad spectrum beta-lactam antibiotics administered by IV or IM. Which of the following medications are classified as carbapenems?

meropenem, doripenem

This is a leukotriene modifier used to cause bronchodilation and reduce inflammation in the airways.

montelukast

This is a medication for hyperlipidemia which can causing flushing of the face and pruritus which may require aspirin to prevent. It can result in hepatotoxicity and elevated liver enzymes

niacin

This anti-viral is used in the treatment of RSV infection in children and is given as an aerosol. It is also used in combination with interferon alfa in the treatment of Hepatitis C

ribavirin

This drug is used to treat tuberculosis and is often combined with INH. It turns all bodily fluids red-orange. It induces the liver's P450 system resulting in the acceleration of the metabolism of anticoagulants, corticosteroids, and others. It is not used in children. Standard treatment for TB is 6 months; resistant TB is 20 months

rifampin

This drug is a protease inhibitor effective in the treatment of HIV by decreasing viral load. It can increase the levels of other protease inhibitors through inhibition of liver enzymes. Retroviruses cannot be completely eliminated by antivirals. In addition to GI disturbances and glucose intolerance, it can cause decreased bone density and abnormal fat distributio

ritonavir

is the term for an antimicrobial drug which can injure/kill the target cell or organism without injuring the person receiving the drug.

selective toxicity

Which anticoagulant is monitored with an International Normalized Ratio (INR) test and reversed with administration of Vitamin K?

warfarin