Pharm Midterm, Pharm Exam 3, Pharm Test 5
Which is correct? a. 2.0 mg b. 0.2 mg c. .2 mg d. 0.20 mg
0.2 mg
What serum concentration of digoxin should be achieved?
0.5-0.8 ng/mL
What is considered a therapeautic plasma level of lithium?
0.8-1.4 mEq/L
A patient presents with proteinuria. The eGFR is >90. This represents CKD stage___________?
1
What is the typical dose (mg/kg/day) of oral prednisone for an asthma exacerbation in a child?
1-2 mg/kg/day
Does asthma get worse with pregnancy?
1/3 get better, 1/3 get worse, and 1/3 stay the same
Statins should be discontinued when the CK level is _______ times the upper limit of normal (ULN)
10
How much weight loss do you need to lower BP by 5-20 mm Hg?
10 kg
The variables in the Pooled Cohort Equation include age, race, total and HDL-cholesterol, systolic BP (including treated or untreated status), diabetes, and current smoking status. This calculation measures the _______ year risk of developing ASCVD and is thought to be more accurate than the Framingham Risk Assessment.
10 year risk
What is the normal plasma level of theophylline?
10-20 mcg/ml. Most patients respond well at 5mcg/ml.
What is the recommended therapeutic serum concentration of phenytoin (Dilantin)?
10-20mcg/ml
Do not start ARNI if the systolic BP is <_______mm/Hg?
100
A patient is being treated with erythropoetin due to HIV therapy. The nurse knows that the Hbg should not be higher than__________% in order to avoid clot formation.
11
To avoid serious cardiovascular events in patients taking erythropoiesis stimulating agents (ESAs), hemoglobin level should not exceed _______ gm/dL?
11 gm/dL. The rise in hemoglobin should not exceed 1 gm/dL in 2 weeks
If the respiratory rate is_______breaths per minute or less, the opioid should be withheld and the prescriber notified?
12
Pregnant women or women that are breastfeeding should limit their intake of fish to ___________ ounces a week to avoid exposure to environmental contaminates such as methylmercury, dioxins, and polychlorinated biphenyls (PBCs).
12
Symptoms of depression resolve slowly with maximal responses seen at about________weeks following initiation of drug therapy
12
In older individuals treatment of depression can be longer. The recommended treatment in the elderly is _____________to___________months?
12-24 months
In calculating ideal body weight a woman 5'5" would weigh:
125 lbs
According to the newest guideline, goal blood pressure is:
130/80
What is the goal BP for patients with chronic kidney disease (CKD)?
130/80 (110 if total protein excretion is < 1 gram/day)
At what BP level should pharmacotherapy be initiated in patients with renal insufficiency or diabetes according to JNC-7?
130/80. JNC-8 does not endorse this however a lot of providers and other organizations still use 130/80 as their goal. JNC-8 is evidence based and uses a target goal of 140/90 for all under age 60 and 150/90 for those over 60. ACC/AHA 2017 guideline has a goal of 130/80 regardless of age.
Calculate ideal body weight for a female 5'8"
140 lbs
At what BP level should pharmacotherapy be initiated in patients without co morbidities who have failed lifestyle changes?
140/90
HTN is defined as a SBP greater than ____________ mm Hg and a DBP greater than _______ mm Hg in individuals 18-29 years old according to JNC 8
140/90. ACC/AHA 2017 endorse >130/80 as Stage 1
A child weighing 57 lbs presents with AOM. The Sanford Guide recommends amoxicillin 90/mg/kg/day for 10 days. Use the suspension amoxicillin 400 mg/5mL and give the dose every 12 hours.
15 mL every 12 hours 57 lbs divided by 2.2 = 25.9 kg 25.9 kg x 90 = 2,331 mg/day 1,165,5 per dose 1,165.5 divided by 400 mg x 5 mL= 14.5 mL Round mL to 15 mL You can also split the dose tid Use the dose calculator in ePocrates to check your work. Rx would look like this:Amoxicillin suspension 400 mg/5 mLDispense 300 mLSig: Take 15 mL every 12 hours for 10 days for ear infection-provide dosing spoon
What is the recommended amount of exercise necessary to reduce risk of ASCVD?
150-300 minutes per week
In individuals greater than age 60, HTN is defined as SBP greater than _________ mm Hg and a DBP greater than _______ mm Hg
150/90
A pregnant woman with seizure disorder should take a dose of________mg/day of folic acid to prevent the risk of neural tube defects?
2 - 5 mg/day
What is the recommended PT INR in patients with atrial fibrillation?
2 -3
How is albuterol MDI dosed?
2 inhalations every 4-6 hours prn
How many readings are necessary to diagnosis HTN?
2-3 at least a week apart
After initiating an ACEI, when should you check the serum creatinine?
2-4 weeks
What is the recommended PT INR for patents with mechanical heart valves?
2.5 - 3.5
Entresto was found to reduce composite endpoints of cardiovascular death or heart failure hospitalization by________?
20%
Plasma HIV RNA is the best measurement for predicting clinical outcome. The goal of therapy is to decrease plasma HIV RNA to less than
20-75
What is the critical level of CD4 T cells seen when patients develop AIDS?
200 cells/mm3
Which of the following BMI measurements is considered overweight?
25
Calculate the estimated GFR for an 80 year old female (non African American). Her weight is 180 lbs and her serum creatinine is 1.9. Use the calculator posted in the learning module.
25-30
Fibrinolytic therapy is most effective when started _____ minutes after arriving to the ED?
30
When are peak levels of antibiotics drawn to monitor serum antibiotic levels?
30 minutes after completing IV dose
Obesity is defined as a BMI of_____________?
30 or more
How much of an increase in the serum creatinine (in percentage) would warrant discontinuing and ACE or ARB?
30%
What would be an acceptable rise in serum creatinine after initiation of an ACEI?
30% from baseline
According to the Beer's Criteria, older adults with anemia should not be given more than___________mg/day of ferrous sulfate?
325
What is the maximum recommended amount of iron replacement in older adults?
325 mg ferrous sulfate daily
What medication taken thirty (30) minutes before taking nicotinic acid (niacin) will prevent the synthesis of prostaglandins which mediate the flushing response?
325 mg of aspirin or ibuprofen
A patient with an EF of <______would be considered to have systolic dysfunction also called heart failure with reduced ejection fraction (HFrEF)?
35%
Do not use ARNI (Entresto) for at least______hours before or after taking an ACEI or ARB?
36
Cough and cold medicines should not be used in children < _______years because they have never been proved to be effective and have the potential for serious harm
4 years
When is thrombolytic therapy most effective?
4-6 hours or sooner from onset of symptoms.
A waist circumference greater than________inches in a man is considered a health risk?
40 inches (35 inches in a female)
Many children approach adult weight at a younger age. Prescribers know that when a child reaches_______in weight, an adult dose is given because if mg/kg/day dosing is calculated, it will be higher than an adult dose (select all that apply)
40-50 kg 88-110 lbs
Once a pediatric patient weighs_____________, it is time to switch to an adult dose.
40-50 kg or 88-110 lbs.
A child weighing 20 kg is prescribed azithromycin 10 mg/kg/day for 3 days. Use the azithromycin suspension 200 mg/5mL
5 mL
A child weighing 30 lbs has strep throat and the NP prescribes PCN 50 mg/kg/day in divided doses every 8 hours for 10 days. The PCN suspension is 250 mg/5mL.
5 mL
What is the ideal plasma level of theophylline?
5 mcg/ml
A patient with a potassium of _________________should not be started on an ACE or ARB?
5.5
Plasma HIV RNA is the best measurement for predicting clinical outcome. The goal of therapy is to decrease plasma HIV RNA to less than______________?
50 copies/mL
How many mg/minute of phenytoin can be administered?
50 mg/min
In order to loose 1 lb a week, how many less calories per week need to be consumed?
500
What is the recommended heart rate to achieve with beta blockade for patients with angina?
60 BPM
What is the typical daily dose of iron for an adult being treated for iron deficiency anemia (IDA)?
60 mg of elemental iron BID-TID or 325 mg ferrous sulfate BID-TID
When a patient with severe allergies reaches a weight of _________lbs., they can transition from the Epi Pen Jr. to the adult dose of 0.3 mg
66 lbs.
How long prior to surgery do antiplatelet drugs need to be discontinued?
7 to 10 days
What is a healthy range for CD4 T cells?
800-1200 cells/mm3
How long of a fast is needed prior to obtaining a lipid profile?
9 - 12 hours is recommended
How long does a patient need to be fasting before a lipid panel is drawn?
9-12 hours is recommended-currently guidelines recommend non fasting
Reduced HDL-C
< 40 mg/dL in men and < 50 mg/dL in women
What is the goal LDL level in patients with diabetes, CAD, CVA, or PVD?
< 70 mg/Dl or a 50% reduction in LDL-C with treatment (ACC/AHA 2018).
Elevated fasting glucose
> 100 mg/dL
Elevated triglycerides
> 150 mg/dL
Elevated waist circumference
> 37 inches in men and > 32 inches in women
What is considered a normal EF?
>40%
Which patient should not receive any atropine like drugs:
A 60-year old with glaucoma
According to federal guidelines, weight-loss therapy is indicated for people with:
A BMI of 30 or more A waist circumference greater than 40 inches (in men) plus 2 risk factors A BMI of 25-29.9 plus two risk factors
A warning that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects is known as____________?
A Black Box Warning.
Acetylcholine
A Neurotransmitter
Prodrug
A compound that is pharmacologically inactive as administered and then undergoes conversion to its active form via metabolism.
Contraindication
A condition that prohibits use of a particular drug under all but the most critical of circumstances.
Following the "rules of two" if asthma symptoms occur >2/week what additional medication is needed?
A controller agent such as an ICS
Why is a "patch-free" interval of 10-12 hours recommended for patients on nitroglycerin?
A daily 10-12 hour "patch-free" interval prevents tolerance. (Tachyphylaxis)
Benzathine penicillin G can be released at a therapeutic amount over one month from a single IM injection, what type of preparation would this be called?
A depot preparation
Define teratogenic.
A drug induced birth defect.
How long does it take an IV drug injected in the anti-cubital space to reach the brain?
A drug injected in the anti-cubital space takes 15 seconds to reach the brain.
Which of the following statements is true regarding drug responses?
A drug with a large or high therapeutic index is safe.
How long should drug treatment for depression last?
A few months after symptoms subside-usually 4-9 months
What it the Asthma Prediction Inventory (API)?
A guide to determining which small children will likely have asthma in later years.
Loading Dose
A large initial dose to hasten time to plateau
What is a loading dose?
A large initial dose to hasten time to plateau
What is creatinine clearance?
A measurement of kidney function and filtration
Why are BB not considered "first line" agents in the treatment of uncomplicated HTN in older adults?
A meta-analysis showed an increased incidence of stroke with BB compared to other classes.
Substrate
A molecule upon which an enzyme acts.
A neonate is defined as (less or more) than 4 weeks of age?
A neonate is less than four weeks old.
Which beta blocker would be beneficial in a patient with symptomatic hyperthyroidism?
A non cardio-selective beta blocker such as propanolol will help manage the tachycardia as well as other symptoms such as tremor
An ACE inhibitor would be the drug of choice in patients with which of the following conditions:
A patient with a HbA1c of 10% A patient with nephrosclerosis due to systemic lupus erythematosis A patient with heart failure
Which of the following patients may have problems with an opioid analgesic:
A patient with a head injury A patient with COPD or asthma Infants Patient taking other drugs with anticholinergic effects A patient with low blood pressure
Which of the following patients with AD would NOT be a candidate for cholinesterase inhibitors?
A patient with asthma A patient with bradycardia A patient taking a tricyclic antidepressant (TCA)
Therapeutic Range
A range of plasma drug levels, falling between the MEC and the toxic concentration
A patient taking levothyroxine and orlistat may need (higher or lower) doses of thyroid replacement?
A reduction in the efficacy of levothyroxine may occur leading to hypothyroidism
Scored
A scoring feature facilitates the practice of tablet splitting.
What measures help reduce adverse reactions of medication administration?
A thorough patient history to identify those who may be high-risk & education.
What is the supra infection due to an overgrowth of Clostridium difficile in the gut as a result of broad spectrum antibiotic therapy?
AAPMC
A woman of childbearing age is found to have hypertension. Which of the following treatments would be problematic?
ACE inhibitor
Ramipril
ACE inhibitor
HTN, heart failure, MI, diabetic and nondiabetic nephropathy, prevention of MI, stroke, and death in high risk patients are some of the uses for _______?
ACE inhibitors
What class of blood pressure medication should not be taken during pregnancy?
ACE inhibitors and ARBs are contraindicated in pregnancy.
Which class of drugs used to treat MI reduces preload and afterload, promotes water loss, favorably alters ventricular remodeling, and decreases overall mortality?
ACE inhibitors.
What classes of antihypertensive drugs are considered vasodilators?
ACEI, ARBs, organic nitrates, CCBs, sympatholytics that dilate vessels.
What is the best time of day to administer a prednisone burst?
AM administration mimics the natural release of cortisol.
State the four systems that regulate arterial pressure
ANS, RAAS, kidneys and natriuretic peptides
What is the difference between ACE inhibitors and angiotensin II receptor blockers (ARBs)?
ARBs block angiotensin at receptor sites and do not cause cough.
Can use of ARBs cause angioedema?
ARBs can cause angioedema. About 8% will get angioedema with an ACEI and an ARB. In some situations, the benefit may outweigh the risk.
Why is ASA given immediately in the event of a suspected MI?
ASA suppresses platelet aggregation, causing an immediate antithrombotic effect
Age, tobacco abuse, diabetes, metabolic syndrome, HTN, obesity, history of MI, low HDL-C, sedentary lifestyle, and positive family history of CAD are all risk factors for ___________?
ASCVD
What are the uses of the adrenergic agonist isoproterenol?
AV block, cardiac arrest and shock
MS (morphine sulfate), MSO4 and MSGO4, > (greater than), < (less than), abbreviations for drug names, apothecary units, @, Cc, ug....all have one thing in common. What is it?
Abbreviations that are on the "Do Not Use List"
What physical assessment finding would indicate renal artery stenosis?
Abdominal bruits
What are the clinical s/s of gallbladder disease?
Abdominal discomfort (RUQ pain), bloating, and intolerance to fried foods.
How much fish oil supplementation is recommended?
About 1 gram/day
How long does it take to achieve therapeautic effect when using fluoxetine (Prozac)?
About 4 weeks are required to produce steady state plasma drug levels.
A patient with NMS has a________% risk of mortality?
About 4%
Why is abrupt discontinuation of a medication discouraged?
Abrupt discontinuation of medications can lead to withdrawal reactions.
Is it necessary to withdraw AEDs gradually?
Abrupt withdrawl can cause seizure activity and possible status epilepticus.
Define the four phases of pharmacokinetics.
Absorption, distribution, metabolism, and excretion.
What are the four (4) basic pharmacokinetic processes?
Absorption, distribution, metabolism, and excretion.
Do AEDs increase suicidal thoughts and behavior?
According to the FDA-yes
Explain how ACE inhibitors can lead to angioedema in rare instances.
Accumulation of bradykinins leads to edema.
Cholinergic receptors react to responses of which neurotransmitter?
Acetylcholine (ACh)
What other receptors are blocked by first generation antipsychotics that contribute to side effectc?
Ach, histamine, alpha1 and NE.
Agonist are molecules that (prevent or activate) receptors.
Activate.
How is heparin monitored and what is the normal range?
Activated partial thromboplastin time (aPTT) : Normal range is 40 seconds.
Nicotinicm Receptor
Activation impacts skeletal muscle
What is the MOA of beta-2 adrenergic agonists?
Activation of beta 2 receptors to dilate bronchials and relieve bronchospasm.
What is the MOA of short acting beta-2 agonists (SABAs) such as albuterol, levalbuterol, and pirbuterol?
Activation of beta-2 receptors relaxes smooth muscles to promote bronchodilation
What is aerobic exercise and how much is recommended daily?
Activity at target HR for 30 minutes most days of the week
What effect does angiotensin II have on aldosterone?
Acts on the adrenal glands to stimulate release of aldosterone
What are examples of extrapyramidal symptoms (EPS)?
Acute dystonia, Parkinsonism, akathesia, and tardive dyskinesia
The server at J. Alexander's restaurant assured Nancy that the french fries were not cooked in the same oil as the seafood. In spite of the warnings, Nancy feels a ball in her throat after ingesting the french fries and self administers the epinephrine. Immediate medical is required following epinephrine injection because:
Additional treatment such as prednisone may be given to manage delayed or persistent symptoms
What is the treatment of angioedema?
Administer epinephrine and discontinue ACEI or ARB.
Oral glucocorticoids have a higher risk of toxicity than ICSs and adverse effects. The most severe complication from oral glucocorticoids is and risk of ______?
Adrenal suppression
(Adrenergic or cholinergic) receptors mediate responses to epinephrine and norepinephrine?
Adrenergic
Do adrenergic or cholinergic receptors mediate responses to epinephrine and norepinephrine?
Adrenergic
Which combination ICS/LABA is approved in children less than 12 years old?
Advair
Explain why ACEIs are not as effective in African Americans.
African Americans have low renin. Angioedema is more frequent in African Americans
When is the safest time for a pregnant woman to receive treatment for trichomonas?
After the first 12 weeks of pregnancy
What are the proven risk factors for AD?
Age and family history are the only proven risk factors or AD
What are the risk factors for tendon rupture in patients prescribed fluoroquinolone antibiotics?
Age, concurrent use of corticosteroids and transplant medications
Centrally acting anticholinergic agents such as benztropine (Cogentin) are sometimes used to reduce tremor and possibly rigidity and are used in younger patients with mild symptoms of PD. In the elderly, the anticholinergic side effects can be problematic. Which of the following is an anticholinergic side effect:
Aggravation of glaucoma
Upon activation of GP llb/llla receptors, fibrinogen forms crosslinks between platelets to allow them to clump at the site of injury. This process is known as platelet_______________?
Aggregation
Why is it important to avoid shaking a vial of epoetin alpha?
Agitation can cause denaturation of the protein rendering it ineffective
When a drug activates receptors directly, it is called an (agonist or antagonist)?
Agonist
Pentazocine
Agonist-antagonist opioid
Pentazocine (Talwin), nalbuphine (Nubain), butorphanol (Stadol) and buprenorphine (Buprenex) are classified as _________________?
Agonist-antagonist opioids or partial agonists
Which of the following statements are true about drugs that act as agonists or antagonists: (Choose all that apply)
Agonists activate receptors. Antagonists block receptors. Partial agonists activate receptors to produce a lower level of intensity than full agonists. Pentazocine (Talwin) is a partial agonist.
Drugs that mimic the body's own regulatory molecules are called (agonists or antagonists)?
Agonists.
Clozapine is a second generation or "atypical" antipsychotic. It's use is limited due to:
Agranulocytosis
Pharmacokinetics in neonates and infants vary because:
Albumin levels are lower in infants
Under what circumstances would you want to initiate an ACEI or ARB in a normotensive patient?
Albuminuria-these drugs are not proven to be helpful for primary prevention of neuropathy (RASS study)
SABA (Short-Acting Bronchodilators)
Albuterol
Black Box Warning from the FDA states that respiratory depression and respiratory arrest can occur when BZDs are mixed with other CNS depressants including opioids and_______?
Alcohol
What are the effects of alcohol on the myocardium in patients with HF?
Alcohol is a direct myocardial toxin and suppressant. It also causes vasoconstriction in the arterial beds. Limit to one drink or less.
Why is the combination of AEDs and chronic use of alcohol problematic?
Alcohol used chronically can decrease plasma levels of AEDs.
Most AEDs cause CNS depression and should not be combined with other CNS depressants such as___________?
Alcohol, antihistamines, opioids, and other AEDs
Patient abusing_________can have deficiencies in B12 and folate due to nutrition and derangement of enterohepatic recirculation secondary to alcohol-induced injury to the liver
Alcohol. Thiamin deficiency is also seen in alcoholics
PCSK9 inhibitors are approved for familial hypercholesterolemia (FH) and patients that are intolerant of statins. What is the drug prototype for PCSK9 inhibitors?
Alirocumab (Praluent) and evolocumab (Repatha)
When should individuals be screened for lipid disorders?
All adults greater than or equal to 20 years of age should have a fasting lipid panel
Where are Nicotinicn receptors located?
All autonomic nervous system ganglia and the adrenal medulla
Which of the macrolide antibiotics can cause QT prolongation?
All of them
Where are Muscarinic receptors located?
All parasympathetic target organs: Eye Heart Lung Bladder GI tract Sweat glands Sex organs Blood vessels
What other conditions often go along with asthma?
Allergic rhinitis, allergic conjunctivitis, eczema and nasal polyps. Some may have sensitivity to NSAIDs
What factors can predispose an individual to adverse reactions from drugs?
Allergies, pregnancy, age, genetics, & pathological disease (kidney or liver)
What type of drugs used to lower blood pressure also help men with benign prostatic hypertrophy (BPH)?
Alpha 1 antagonist or alpha blockers such as prazosin, doxazosin, & alfuzosin.
Activation of ___________________receptors have the following effects: Blood vessels constriction Sexual apparatus ejaculation The smooth muscle contraction of the bladder neck and prostatic capsule.
Alpha 1 receptors
Activation of ___________________receptors have the following effects: Blood vessels constrictionSexual apparatus ejaculation, and the smooth muscle contraction of the bladder neck and prostatic capsule?
Alpha 1 receptors
Which adrenergic receptors are located in the eye, arterioles, viscera and mucous membranes, veins, male sex organs, & prostate capsule?
Alpha 1 receptors
Which adrenergic receptors are activated with the use of epinephrine?
Alpha 1, alpha 2, beta 1 and beta 2.
State the subtypes of adrenergic receptors.
Alpha 1, alpha 2, beta 1, beta 2, and dopamine
Activation of ___________________receptors have the following effects: Inhibition of transmitter release-↓ SNS flow
Alpha 2
Clonidine
Alpha 2 agonist (indirect acting antiadrenergic)
Methyldopa
Alpha 2 agonist (indirect acting antiadrenergic)
Doxazosin
Alpha blocker
Orthostatic hypotension, reflex tachycardia, inhibition of ejaculation and nasal congestion are adverse effects of which category of drugs?
Alpha blockers such as Minipress (prazosin) and Cardura (doxazosin).
Floppy iris syndrome can occur with the use of__________?
Alpha-adrenergic antagonists (alpha blockers)
What types of antacids cause constipation?
Aluminumm hydroxide
Memantine (Namenda) modulates the effect of an excitatory transmittor (glutamate) at the NMDA receptors which are important for memory and learning. It is a newer agent used to treat__________?
Alzheimer's disease. Menantine is used in patients with moderate-severe AD.
Name a commonly used Class III antiarrhythmic agent that can increase the risk of torsades if used with antibiotics such as macrolides
Amiodarone
A patient on amiodarone complains of a nonproductive cough and dyspnea. Why is it necessary to do a CXR?
Amiodarone can cause pulmonary fibrosis
One example of a CCB that is classified as a dihydropyridine is______?
Amlodipine.
What agent for UTI would be considered safe in a pregnant woman?
Amoxicillin
What are the components of Augmentin?
Amoxicillin & clavulanic acid (a beta-lactamase inhibitor)
What antibiotics are considered first line for treatment of AOM?
Amoxicillin or Augmentin
Rigors, fever, chills, nausea, HA, Infusion reactions, nephrotoxicity, hypokalemia, bone marrow suppression, delirium, hypo-hypertension, wheezing, hypoxia are side effects of which antifungal agent?
Amphotericin B
What is the drug of choice for systemic mycoses despite its potential for serious harm?
Amphotericin B
A patient with migraines is prescribed sumatriptan (Imitrex) for abortive therapy. The patient should be warned about serotonin syndrome and refrain from using which of the following:
Amytriptyline Venlafaxine (Effexor) Fluoxetine (Prozac) Dextromethorphan
What is a partial agonist?
An agonist that has less effect than a full agonist.
Partial Agonist
An agonist that has only moderate intrinsic activity. As a result, the maximal effect that a partial agonist can produce is lower than that of a full agonist.
What is atopy?
An allergy, involving an inherited immunoglobulin of the IgE type that predisposes a person to certain allergic responses. Atopic individuals often have asthma, atopic dermatitis (eczema) and allergic rhinitis
Cholinesterase
An enzyme that causes the breakdown of acetylcholine
Succinylcholine, a drug used to promote flaccid paralysis of skeletal muscle, can cause paralysis. In most patients, the paralysis is brief. However, in some patients the genes that code for succinylcholine-metabolizing enzymes are abnormal, producing enzymes that inactivate the drug slowly leading to prolonged paralysis. What type of effect is this?
An idiosyncratic effect.
Why was a Black Box Warning recently issued for hematopoeitic drugs that are given to increase RBCs such as Aranesp and Procrit?
An increase in mortality and serious CV events in patients with CRF was found
Do nasal corticosteroids reduce congestion immediately?
An initial response can be seen with in hours, maximal responses take 2-3 weeks to develop.
Synergistic
An interaction between two or more drugs that causes the total effect of the drugs to be greater than the sum of the individual effects of each drug.
Which of the following drugs is most likely to have a significant "first-pass" effect:
An oral agent
Define idiosyncratic effect from a drug.
An uncommon drug response resulting from a genetic predisposition.
What is a life threatening response characterized by bronchospasm, laryngeal edema, and drop in BP?
Anaphylaxis.
State the adverse effects of nucleoside reverse transcriptase inhibitors (NRTIs).
Anemia, neutropenia, lactic acidosis, myopathy, GI and CNS effects
Over-the-counter medications such as phenylephrine or pseudoephedrine used for cold symptoms have sympathetic properties and are contraindicated in patients diagnosed with which disease process or symptom?
Angina Hypertension Coronary artery disease
The American Heart Association now recommends against using beta blockers as first-line therapy in patients without compelling indications. Which of the following are considered "compelling indications" for the use of beta blockers?
Angina Systolic heart failure Tachydysrhythmias Prior myocardial infarction
Beta blockers are used for:
Angina, HTN, dysrhythmias, MI, reduction of perioperative mortality, heart failure, hyperthyroidism, migraine prophylaxxis, pheochromocytoma, and glaucoma
What are the therapeutic uses for verapamil?
Angina, hypertension, and cardiac dysrhythmias.
What is a life threatening reaction that can occur with the use of ACE inhibitor and less frequently with ARBs?
Angioedema
Vasoconstriction and stimulation of aldosterone release as well as pathologic structural changes in the heart and blood vessels (hypertrophy and remodeling) are the prominent actions of _______________?
Angiotensin II
Candasartan
Angiotensin Receptor Blocker
What class of drugs block the conversion of angiotensin I into angiotensin II, increase levels of bradykinin, dilate blood vessels, reduce blood volume, and prevent cardiac remodeling?
Angiotensin converting enzyme (ACE) inhibitors.
What would you warn pregnant women about ciprofloxacin?
Animal studies show disruption of intracellular matrix of cartilage
Iron absorption can be impaired when combined with_________?
Antacids and tetracycline. Avoid taking any meds with iron.
Inflammatory mediators such as leukotrienes are similar to histamine and can increase airway inflammation and bronchoconstriction. Leukotriene _________ can improve the effect of inflammation and improve asthma symptoms.
Antagonists
What is AAPMC?
Antibiotic associated pseudomembranous colitis
What can occur when there is an overgrowth of Clostridium difficile in the colon?
Antibiotic associated pseudomembranous colitis (AAPMC)
Tricyclic antidepressants are not the first choice for most providers for the following reasons:
Anticholinergic effects are problematic Cardiac toxicity Hypotension
Why would a patient with AD taking a cholinesterase inhibitor be advised not to take an antihistamine for cold symptom relief?
Anticholinergic effects from antihistamines negate the effect of the AD drug.
State other names for muscarinic antagonists
Anticholinergic, parasympatholytics, antimuscarinic drugs, muscarinic blockers.
Drugs to treat urge incontinence are (anticholinergics or muscarinic agonists)?
Anticholinergics are used to treat urge incontinence.
Other than beta 2 agonists, what other class of drugs can be used for bronchodilation?
Anticholinergics such as ipratropium (Atrovent) and tiotropium (Spiriva)
What class of drugs can be used to treat acute dystonia?
Anticholinergics.
What are the drug classes that should be avoided in patients with Stage III CHF?
Antidysrhythmics, CCBs (verapamil and diltiaem) and NSADIs
Drugs that suppress the discharge of neurons within a seizure focus and suppress propagation of seizure activity from the focus to other areas of the brain are called_____________________?
Antiepileptic drugs (AEDs)
A 70 year old male with benign prostatic hypertrophy (BPH) has a worsening of symptoms of urinary retention after taking an over the counter (OTC) remedy for an upper respiratory syndrome. The medication was most likely:
Antihistamine
Clopidogrel (Plavix)
Antiplatelet agent
Why should alcohol be avoided with concomitant use of antipsychotics?
Antipsychotics can intensify CNS depression
Bupropion has amphetamine like properties and can cause weight loss. It is very stimulating and is known to worsen______________?
Anxiety
What are the adverse effects of MAOI's?
Anxiety, agitation, hypomania, orthostatic hypotension, and HTN crisis.
State the therapeutic uses of BZDs.
Anxiety, insomnia, and seizure disorder
Buspirone (Buspar) is used to treat ____________?
Anxiety. It does not cause CNS depression and has no potential for abuse.
Receptors
Any functional macromolecule in a cell to which a drug binds to produce its effects. The special chemical sites in the body that most drugs interact with to produce effects.
Metabolite
Any substance produced during metabolism (digestion or other bodily chemical processes).
What is the typical dose of prednisone (prednisone burst) prescribed to an average weight individual with an asthma exacerbation?
Approximately 40 mg daily for 5 days.
Loperamide on its own can be abused and is considered the poor man's methadone." Adverse effects when taking 4 times the maximum daily dose of 16 mg can lead to______________and__________?
Arrhythmias and cardiac arrest Prescriber's Letter July 2016)
What is the leading cause of death in patients with HF?
Arrhythmias can cause sudden cardiac death
Select the true statements about factors that affect cardiac output:
Arterial constriction (hypertension) will increase afterload Arterial dilation will decrease afterload
Antiplatelet drugs are used to prevent thrombosis in arteries or veins?
Arteries
Hydralazine and minoxidil cause selective dilation of (arterioles or veins)?
Arteries
Calcium Channel Blocker site of vasodilation
Arterioles
Hydralazine site of vasodilation
Arterioles
ACE Inhibitors site of vasodilation
Arterioles and Veins
Alpha blockers site of vasodilation
Arterioles and Veins
Angiotensin Receptor Blocker site of vasodilation
Arterioles and Veins
Direct Renin Inhibitors site of vasodilation
Arterioles and Veins
Nitroprusside site of vasodilation
Arterioles and Veins
Where are beta 2 receptors located?
Arterioles in the heart, lung and skeletal muscle, bronchi, uterus, and liver.
Where are beta2 receptors located?
Arterioles in the heart, lung and skeletal muscle, bronchi, uterus, and liver.
Carbemazepine and phenytoin can cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis TEN) due to a genetic mutation known as HLA-B*1502. There is testing for this mutation and patients of_________decent should be screened.
Asian
Which ethnic group has increased risk of SJS/TEN with administration of AEDs because of variations in the HLA-B*1502 gene?
Asian
Which racial group requires smaller doses of rosuvastatin (Crestor) or atorvastatin (Lipitor) because of genetic differences in metabolism?
Asians- in general start with lower doses in this group
Which drug suppress platelet aggregation by causing irreversible inhibition of cyclooxygenase?
Aspirin (ASA)
What is an Asthma Action Plan?
Assessment of symptoms and directions for care
By measuring lung function (FEV1) forced expiratory volume by spirometry less than 80% predicted with a 12% improvement of FEV1 after bronchodilation confirms the diagnosis of ________?
Asthma
Give an example of 2 conditions that would require treatment regardless of the risk of the medications.
Asthma and epilepsy are examples.
Beta2 agonist are used for
Asthma and preterm labor
How is asthma diagnosed?
Asthma is diagnosed based on a physical examination, personal history, and lung function tests. The physical examination looks for typical asthma symptoms such as wheezing or coughing, and the personal history provides additional clues such as allergies or a familial tendency towards asthma. Lung function tests may be as simple as measuring peak flow with a peak flow meter, or using a simple spirometer, or may involve a battery of spirometry tests in a pulmonary function lab.
What is "cough variant asthma?"
Asthma that presents with coughing without wheezing
At what age does hepatic maturation occur?
At about 1 year after birth.
ASCOT-BPLA, what drug was associated with a 16% higher relative risk of stroke compared to others?
Atenolol (cardioselective BB)
Which non stimulant used to treat ADHD has a small risk of liver failure?
Atomoxetine (Straterra)
Which drugs used for ADHD at not stimulants?
Atomoxetine (Strattera), guanfacine, clonidine, and antidepressants
Which statins are considered "moderate intensive statins" to lower LDL-C 30-50%?
Atorvastatin 10-20 mg; fluvastatin 40 mg BID; fluvastatin XL 80 mg; lovastatin 40 mg; pitavastatin 2-4 mg; rosuvastatin 5-10 mg; simvastatin 20-40 mg
Which of the statins are considered "high intensity" statins to lower LDL-C greater than or equal to 50%?
Atorvastatin 40-80 mg; rosuvastatin 20-40 mg
Which four statins inhibit the metabolism of cyclosporine, macrolide antibiotics, azole antifungals, and protease inhibitors leading to increased levels of statins and possible toxicity?
Atorvastatin, fluvastatin, lovastatin, and simvastatin
Blurry vision, photophobia, increased intraocular pressure, urinary retention, dry mouth, constipation, anyhidrosis, and tachycardia and sedation (BUDCATS) are adverse effects of ________________?
Atropine (anticholinergic agent)
What drug should be available to treat a patient with a confirmed cholinergic crisis?
Atropine (anticholinergic agent)
What is the treatment of muscarinic poisoning?
Atropine (anticholinergic agent)
Name an anticholinergic agent that is sometimes used for vasomotor rhinitis.
Atrovent nasal spray is a nasal preparation of ipratropium and is effective at drying secretions with the common cold or with vasomotor rhinitis that occurs with cold weather. It is costly
Trazodone
Atypical antidepressant that causes priapism
Mirtazapine
Atypical antidepressant that is sedating
Bupropion
Atypical antidepressant that is stimulating
Which classification of antipsychotics have a greater effect on the negative symptoms and cognitive dysfunction that occurs in schizophrenia?
Atypical antipsychotic (second generation) agents (this is debatable)
In addition to divalproex sodium and lithium, what other drugs are approved to treat BPD?
Atypical antipsychotics or second generation antipsychotics such as olanzapine
What are the later onset non-motor symptoms of PD?
Automatic disturbances, sleep disturbances, depression, dementia, and psychosis
Give some example of foods high in potassium that should be avoided in patients on drugs that elevate the potassium.
Avocado, peanuts, bananas, dried fruit, OJ
What are the major drug reactions with the use of theophylline?
Avoid caffeine, alcohol and tobacco products. May react with Allopurinol (Aloprim, Zyloprim), certain antibiotics, benzodiazepines, .certain seizure medications, Fluvoxamine (Luvox), Estrogen replacement, St. John's Wort and others. Consult healthcare provider.
What are environmental control measures that help decrease asthma symptoms?
Avoid dust mites pets, cockroaches, molds, tobacco smoke, weeds, & grasses.
How does the treatment of vaginal candidiasis differ in pregnant women?
Azoles are given intravaginally x 7 days instead of orally
A patient who is a vegan will have trouble ingesting which micronutrient?
B12
DNA synthesis requires the presence of which vitamins?
B12 and folic acid. Calcium and vitamin C are also needed
Why should patient with numbness, weakness, and changes in neurologic status be assessed for B12 deficiency?
B12 deficiency can cause neurologic symptoms that may not be reversisble
In addition to lifestyle changes, what are the four drugs recommended after a MI to reduce morbidity and mortality?
BB, ACEI or ARB, antiplatelet drug, and a statin taken indefinitely
What drugs are used to treat angina?
BBs, CCBs, nitrates
How is Advair 500/50, 250/50, 150/50 dosed?
BID (The salmeterol component of 50 mg is constant)
How is white coat HTN defined?
BP >140/90 in the clinic with a concomitant normal BP reading <135/85
TCAs are second and third line drugs for depression. What are some of the other therapeutic uses of TCAs?
BPD, fibromyalgia, neuropathic pain, and migraine prophylaxis
What are the adverse effects of centrally acting anticholinergics such as benztropine (Cogentin)?
BUDCATS
What are the s/s of antimuscarinic poisioning?
BUDCATS
Describe the MOA of benzodiazepines (BZDs).
BZDs potentiate the actions of GABA, an inhibitory neurotransmitter.
Why are implantable defibrillators and radiofrequency ablation often preferred over antidysrhythmic drugs?
Because drug therapy of dysrhythmias is highly empiric, even if dysrhythmia has been identified we cannot predict that the drugs will be effective. They often lead to more dysrhythmias.
Why do patients with HF have increased SNS activation?
Because of a decrease in cardiac output-this is one reason why BBs are helpful
Why do think that clonidine might be a drug of abuse?
Because of the sedating effects
Why are MAOI's rarely used?
Because of their poor safely profile.
Why are patients with renal failure treated with epoetin alpha to reverse the anemia associated with declining renal function?
Because these patients have a deficiency in erythropoietin due to renal decline
When should a Comb's test be drawn in a patient who is taking methyldopa?
Before treatment, at 6 months and 12 months
When should children be screened for lipid disorders?
Beginning as young as age 2 in families with a history of lipid disorders
Name a few cholesterol lowering margarine like products that can lower LDL by 10-15%.
Benacol (from pine pulp), Take Control (from soybeans), and Smart Balance.
Give an example of a Schedule IV drugs.
Benzodiazepines.
Activation of ______________receptors has the following effects: Arterioles (heart, lung and skeletal muscle)- dilation Bronchi- dilation Uterus- relaxation Liver- glycogenolysis Skeletal muscle- enhanced contraction, glycogenolysis?
Beta 2 receptors
Activation of ______________receptors has the following effects: Arterioles (heart, lung and skeletal muscle)- dilation; Bronchi- dilation Uterus- relaxation; Liver- glycogenolysis; Skeletal muscle- enhanced contraction, glycogenolysis
Beta 2 receptors
Albuterol is receptor-selective for which type of receptors that causes bronchodilation?
Beta 2 receptors.
Which of the following can cause sexual/erectile dysfunction:
Beta blockers Thiazide diuretics SSRIs Alcohol Antipsychotics
How do beta blockers impact glycogenolysis (breakdown of glycogen stores to glucose)?
Beta blockers can reduce glycogenolysis making it more difficult for a patient with diabetes to recover from a low blood sugar
What is the problem with beta blockers and diabetics?
Beta blockers mask the s/s of hypoglycemia and prevent glycogenolysis.
Which class of drugs is used to help prevent vasodilator-induced reflex tachycardia?
Beta blockers such as metoprolol.
Which drugs are used for preventive therapy of migraines when patients have 3 or more migraines a month?
Beta blockers such as propranolol (non cardio-selective), AEDs such as topiramate and Decakote ED, TCAs such as amitriptyline, Botox injections, ACEIs and ARBs
What class of drugs used to treat MI can reduce ventricular rate and force of contractility, reduce MVO2, reduce O2 demand by lowering blood pressure, prolong diastolic filling time, increase coronary blood flow and myocardial O2 supply, and provide antidysrhythmic actions
Beta-blockers.
What agents are added to antibiotics to extend their antimicrobial spectrum?
Beta-lactamase inhibitors.
Examples of Cholinergic Drugs
Bethanechol Muscarine Neostigmine Donepezil (Aricept)
Which agent has been shown to be effective in African Americans with HF?
BiDil (hydralazine and isorbide
What lipid lowering agent would be suitable in a patient that had liver disease or was pregnant?
Bile acid sequestrants are not systemically absorbed and are safe in patients with liver disease or pregnancy. Vitamins should be separated to avoid inactivation.
Which cholesterol lowering drugs can decrease the bioavailability of other drugs?
Bile acid sequestrants such as cholestyramine need to be taken separate from other drugs (1 hour before or 4-6 hours after). The newer agent colesevelam (Welchol) has less problems with absorption of other drugs or vitamins.
Name the prescription lipid lowering agent that does not require monitoring of liver function.
Bile-acid sequestrants do not require monitoring of liver function.
What is the drug class that lowers LDL cholesterol through a mechanism that ultimately depends on increasing LDL receptors on hepatocytes. Following ingestion, these drugs form insoluble complexes with bile acids present in the intestine. This complex prevents the reabsorption of bile acids, and thereby accelerates their excretion.
Bile-acid sequestrants, cholestyramine (Questran) or colesevelam (Welchol)
Protein Binding
Binding of drugs to albumin and other plasma proteins is limited in the infant, because The amount of serum albumin is relatively low Endogenous compounds (e.g., fatty acids, bilirubin) compete with drugs for available binding sites.
The ability of a drug to reach the systemic circulation from its site of administration is known as what?
Bioavailability.
Alternating episodes in which mood is abnormally elevated or abnormally depressed, seperated by periods in which mood is relatively normal are all clinical manifestations of _____________.
Bipolar disease (BPD)
Neuropletic agents are used for schizophrenia and_________
Bipolar disorder, depression, emesis, dementia, and Tourette's syndrome
Diarrhea caused by infectious agents usually runs it course and the offending agent is expelled. Drugs that slow the peristalsis may delay export of the offending organism and prolong the infection. In certain circumstances, anti-diarrheal agents are appropriate. Which of the following are used to manage diarrhea?
Bismuth subsalicylate (Pepto-Bismol) Methylcellulose Diophenoxylate (Lomotil) Paregoric
Improper use of the long acting beta-2 agonists such as salmeterol can cause death because the bronchodilating effect is delayed. Deaths associated with the improper use of salmeterol lead to_______________?
Black Box Warning
A patient presents with elevated liver transaminases (ALT, AST). The nurse asks about dietary supplements, the use of alcohol, and acetaminophen. Which of the following dietary supplements have the potential for liver injury?
Black cohosh Kava
Platelets require serotonin for aggregation. SSRIs block reuptake making less serotonin available in the blood. What is the risk to the patient?
Bleeding
What are the major complications of thrombolytic therapy?
Bleeding (the greatest concern is intracranial hemorrhage).
What happens when warfarin and fluoxetine (Prozac) are used together?
Bleeding can occur when Prozac displaces warfarin from the albumin molecule.
Describe the MOA of thiazide diuretics.
Block reabsorption of sodium and chloride in the distal convulated tubule
Class IV antidysrhthmics - verapamil and diltiazem (CCBs) can be used to treat supraventricular dysrhythmias. What are the major adverse effects on BP and HR?
Blockage of the cardiac calcium channels can cause bradycardia, AV block, and heart failure. Blockage of the calcium channels in vascular smooth muscle can cause vasodilation, resulting in hypotension and peripheral edema. Blockage in the intestinal smooth muscle can cause constipation.
How do H2 receptor blockers promote ulcer healing?
Blocking H-2 receptors decreases acid production in the stomach.
ASA and NSAIDs in sensitive individuals can provoke bronchoconstriction. What is the mechanism?
Blocking of COX 1 will decrease prostaglandins and increase production of leukotrienes
How do alpha antatagonists lower blood pressure?
Blocking of alpha receptors on blood vessels leads to dilation and BP lowering.
How do alpha antagonists lower blood pressure?
Blocking of alpha1 receptors on blood vessels leads to dilation and BP lowering.
Describe the MOA of spironolactone.
Blocks aldosterone in distal nephron, potassium is retained, sodium is excreted
Describe the MOA of furosemide (Lasix).
Blocks reabsorption of sodium and chloride in the ascending loop of Henle
Anticholinergic
Blocks the actions of acetylcholine
What are the most common causes of Iron Deficiency Anemia?
Blood loss, pregnancy, and blood volume expansion during infancy/childhood.
What are the four drugs/classes that cause the greatest number of adverse reactions?
Blood thinners, insulin, digoxin, and sulfonylureas.
What occurs in the blood vessels and capillaries when histamine 1 receptors are stimulated?
Blood vessels dilate, and capillary permeability increases leading to swelling
Anticholinergic side effects include all of the following: (choose all that apply)
Blurry vision Urinary retention Dry mouth
Centrally acting muscle relaxants like carisoprodol (Soma) and cyclobenzaprine are problematic in older adults because of the anticholinergic side effects which include:
Blurry vision, urinary retention, dry mouth, constipation, anhidrosis, and tachycardia and sedation (BUDCATS)
What is the most common adverse effect of filgrastim (Neupogen)?
Bone pain can be a severe side effect of filgrastim
Why are ACE inhibitors and potassium-sparing diuretics problematic?
Both can lead to hyperkalemia
What could be the potential problem in using fluoxetine (Prozac) in a patient on warfarin therapy?
Both drugs are highly bound to protein. Displaced warfarin can cause bleeding.
A patient on and SSRI is also prescribed tramadol. What is the potential problem with this combination?
Both drugs are serotonergic agents and can cause serotonin syndrome
A patient on a lipid lowering drug (simvastatin) is prescribed erythromycin for an infection. The patient calls the office with a complaint of muscle aches. What is the most probable mechanism for this adverse reaction? Please learn how to use the interaction checker on ePocrates)
Both drugs use the same metabolizing enzyme systems and the erythromycin inhibited the metabolism of the simvastatin leading to toxic levels.
Why are atorvastatin and rosuvastatin considered high intensity statins?
Both have longer half lives and are thus more potent
SNRIs are often prescribed to individuals with more severe depression or those that don't respond to SSRIs. Which of the following statements are true regarding SNRIs?
Both serotonin and norepinephrine levels are increased at the synapse by blocking reuptake Duloxetine (Cymbalta) has indications for peripheral neuropathy SNRIs can increase blood pressure Discontinuation should be gradual due to a withdrawal syndrome Duloxetine (Cymbalta) can cause liver injury
ACEIs contribute to blood pressure lowering by dilation of veins or arterioles?
Both....in contrast, CCBs dilate only the arterioles
What are additional AE of clonidine?
Bradycardia and rebound hypertension
A patient with Alzheimer's disease is seen in the clinic and the nurse provides information regarding the side effects of donepezil (Aricept). Which of the following statements are true about the effects of donepezil?
Bradycardia can cause dizziness and contribute to falls Acetylcholine (ACh) levels are increased Nausea and diarrhea are common side effects
the contraindications for using digoxin
Bradycardia, AV block, sick sinus syndrome, WPW syndrome, cardiomyopathy, and hypo-or hyperkalemia
What is the side effect of greatest concern when ACh levels are increased?
Bradycardia, leading to fainting, falls, fracture and the need for a pacemaker
What are some of the major adverse effects of beta blockers?
Bradycardia, reduced cardiac output, AV block, bronchoconstriction, reduced glycogenolysis, and masking of tachycardia in the event of hypoglycemia in patients with DM
There are 3 types of pain stimuli mechanical (pressure), thermal and chemical. The chemical stimuli consist of_______________?
Bradykinin, serotonin, and histamine
What do beta-lactamases secreted by the bacteria do to PCN?
Breakdown the beta-lactam ring on the antibiotic rendering them inactive
Propranolol is a non-cardioselective beta blocker that can lead to (bronchoconstriction or bronchodilation)?
Bronchoconstriction
What occurs in the bronchi with the release of histamine from the mast cells?
Bronchoconstriction
Administration of epinephrine leads to (bronchoconstriction or bronchodilation)?
Bronchodilation
Epinephrine is the drug of choice for treating anaphylaxis. Stimulation of adrenergic receptors leads to (bronchoconstriction or bronchodilation)
Bronchodilation occurs with activation of beta2 receptors with epinephrine
Meperidine (Demerol) is not recommended for treatment of cancer pain because of its short half-life and _______________?
Build up of a toxic metabolite
Give examples of Schedule III drugs.
Buprenorphine, anabolic steroids
Which atypical antidepressant can cause weight loss?
Bupropion
Which of the following medications have been shown to cause weight loss:
Bupropion Topiramate Exenatide (Byetta) Phentermine (Adipex)
Which of the following drugs used to treat depression can increase the risk of seizures?
Bupropion (Zyban)
Per os (PO)
By Mouth
How do neuroleptics cause orthostatic hypotension?
By blocking alpha1 adrenergic receptors on blood vessels preventing compensatory vasoconstriction when the patient stands
How do neuroleptics suppress emesis?
By blocking dopamine receptors in the chemoreceptor trigger zone of the medulla
How do neuropletic agents cause Parkinsonism?
By blocking dopamine receptors in the striatum
How do neuroleptics cause sedation?
By blocking histamine1 receptors in the CNS
How does digoxin improve contractility?
By increasing intracellular calcium
What is the MOA of monoamine oxidase inhibitors (MAOIs)?
By inhibiting MOA, more norepinephrine and serotnin are available for release.
Parenteral
By injection. The principal parenteral routes are intravenous, subcutaneous, and intramuscular.
How does decreased amounts of ACh improve symptoms in patients with Parkinson's disease?
By restoring the balance between ACh and dopamine.
How does the brain suppress pain conduction?
By using endogeonous compounds such as enkephalins and endorphins
A patient on carbamazepine develops an infection. Which of the following labs are important to monitor in patients on this drug?
CBC
What laboratory test should be monitored when clozapine is prescribed?
CBC is needed because agranulocytosis can occur with the use of clozapine.
In addition to a Comb's test, which other lab tests need to be ordered when a patient is prescribed methyldopa?
CBC to look for anemia due to hemolysis and CMP to assess liver function
What lab test should be closely monitored in patients taking carbamazepine?
CBC. Leukopenia, thrombocytopenia, and anemia are AEs of cabamazepine.
A patient with angina and co-morbid asthma, depression, and/or PVD should be treated with (BBs or CCB)?
CCB, BB's will worsen these conditions
A patient presents with complaints of constipation, worsening of dyspepsia, and swelling around the ankles. The patient was recently started on an antihypertensive drug. Which class is most likely to cause these side effects?
CCBs
A patient presents with bilateral lower leg edema. Which agent used for HTN could be causing the problem?
CCBs (both types)
Are CCBs useful in heart failure?
CCBs (verapamil and diltiazem) are negative inotropics and decrease contractility
Increased plasma levels of CGRP (promote or decrease) migraine?
CGRP promotes migraine
A patient has an eGFR of 20. What stage of chronic renal failure does this represent?
CKD Stage 4
List agents that should be avoided while taking BZDs.
CNS depressants, alcohol, barbiturate, and opioids.
A 74 year-old patient presents to the clinic with back pain and back spasm and is prescribed a muscle relaxant such as cyclobenzaprine (Flexeril). The side effect of greatest concern is:
CNS depression
Describe the side effects of barbiturates.
CNS depression and cardiovascular effects (decreased BP and HR).
State the adverse effects from centrally acting muscle relaxants.
CNS depression: drowsiness, dizziness, weakness & fatigue
State the adverse effects of BZDs.
CNS, and respiratory depression, anterograde amnesia, and abuse.
Activity of CYP 2D6 is (lower or higher) in Asians and may require (lower or higher) doses of drugs utilizing this metabolizing enzyme?
CYP 2D6 activity is lower. Lower doses are needed in Asians.
How is hyperkalemia treated?
Cacium gluconate, glucose & insulin are given to promote uptake into cells
This drug is a methylxanthine with pharmacologic properties like those of theophylline. It also intensifies the adverse effects of theophylline on the CNS and the heart. This drug competes with theophylline for drug metabolizing enzymes, thereby causing theophylline levels to rise and forms should be avoided. What is__________?
Caffeine
Non-Dihydropyridine (DHP) Calcium Channel Blockers
Calan Verapamil Diltiazem Cardizem Can elevate levels of digoxin by 60% Cause constipation May exacerbate heart failure Can lead to peripheral edema Used for hypertension Reduce force of contraction Used to treat atrial fibrillation and atrial flutter Are useful for treatment of angina Can be problematic if combined with beta blockers Have negative inotropic actions Cause bradycardia Class IV antidysrhythmic agents Have renal protective effects
Which class of drugs block calcium channels in the arterioles and in the heart but have no significant effect on veins?
Calcium channel blockers (CCBs)
In variant angina, these drugs promote relaxation of coronary artery spasm, thereby increasing cardiac oxygen supply. In stable angina, they promote relaxation of peripheral arterioles; the resultant decrease in afterload reduces cardiac oxygen demand. What drugs are these?
Calcium channel blockers.
White and curdy vaginal discharge, burning and itching is likely caused by _________?
Candidiasis or moniliasis
When writing the names of drugs, generic names are not capitalized and brand name are____________?
Capitalized
Extended Release (ER)
Capsules filled with tiny spheres that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, the drug is released steadily throughout the day.
Sustained- Release
Capsules filled with tiny spheres that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, the drug is released steadily throughout the day.
Captopril was the first ACEI on the market. Why are other ACEIs favored?
Captoril is short acting and requires multiple daily doses and this is not convenient for long term use. The risk of neutropenia is greater with captopril. Lisinopril is long acting and free at Publix....
CNS symptoms (nystagmus, ataxia), rash, anemia, leukopenia, thrombocytopenia, and birth defects are all major side effects of which AED?
Carbamazepine. Monitor CBC in individuals being treated with this AED.
Which beta blockers are referred in patients with asthma and or diabetes?
Cardio-selective beta blockers
Which of the following are true statements about beta adrenergic antagonists (beta blockers)?
Cardio-selective beta blockers are a better choice for patients with asthma Abrupt withdrawal of beta blockers can lead to rebound cardiac excitation (palpitations and sometimes angina) Beta blockers can mask the symptoms of hypoglycemia which is often tachycardia
Atenolol (Tenormin)
Cardioselective Beta Blocker
Bisoprolol (Zebeta)
Cardioselective Beta Blocker
Nebivolol (Bystolic)
Cardioselective Beta Blocker
Lopressor
Cardioselective Beta Blocker Mask the s/s of hypoglycemia
Metoprolol
Cardioselective Beta Blocker Mask the s/s of hypoglycemia
What is the most serious adverse effect of TCAs.
Cardiotoxicity
Drugs used to treat the neuropsychiatric symptoms of AD are commonly used but not recommended. Antipsychotic drugs employed can increase mortality mainly from_____________?
Cardiovascular events and infection (Black Box warning)
Select the beta adrenergic antagonists that block both beta and alpha receptors to lower blood pressure:
Carvedilol Labetalol
Which beta blocker has been found to decrease albumin excretion and not affect HbgA1C
Carvedilol (Coreg)
Adrenergic agonist Prototype and MOA
Catecholomine: Epinephrine MOA: Activates Alpha 1, Alpha 2, Beta 1, and Beta 2 receptor types Noncatecholamine: PhenylephrineMOA: Activates Alpha 1 receptors to constrict blood vessels
Which FDA pregnancy risk category shows risk of fetal harm in women or animals whereby the risks clearly outweigh any possible benefit?
Category X (this classification has been phased out. Epocrates states that it is contraindicated
Define iatrogenic.
Caused by medical intervention.
Indirct acting antiadrenergic agents prototype and MOA
Centrally acting alpha 2 antagonists: Clonidine MOA: alpha 2 receptors activate in CNS which causes a decrease in SNS outflow to blood vessels and to the heart to decrease blood pressure and pain.
Benztropine
Centrally acting anticholinergic
Which drugs used to treat PD are on the Beer's list?
Centrally acting anticholinergics such as benztropine and trihexyphenidyl are problematic in older individuals because of the adverse effects of anticholinergic agents (BUDCATS)
What can occur if BP is lowered too rapidly?
Cerebral or coronary ischemia
How is the definitive diagnosis of tuberculosis made?
Chest x-ray and microbiological evaluation of sputum
Patients receiving antibiotic treatment for gonorrhea may also require azithromycin (Zithromax) 1gm po x1 or doxycycline (Vibramycin) 100mg po q12h x 7 days if they have a __________ co-infection.
Chlamydia
Which antibiotic is associated with a potentially fatal toxicity observed most commonly in newborns called Gray syndrome? Initial S/S include vomiting, abdominal distention, cyanosis, and gray discoloration of the skin. Reversible bone marrow suppression and aplastic anemia can occur.
Chloramphenicol
Give two examples of conventional or first generation neuroleptics.
Chlorpromazine (Thorazine) and haloperidol (Haldol).
Which thiazide diuretic was used in the ALLHAT study that demonstrated efficacy of thiazides?
Chlorthalidone
How do chlorthalidone and HCTZ differ?
Chlorthalidone is stronger because it has a longer half life. It can also cause more hypokalemia than HCTZ
Activation of (adrenergic or cholinergic) receptors would have the following effect on: Glandular secretion- increase; Bronchi- constriction; Bladder- voiding GI tract- salivation, increased gastric secretions, increased intestinal tone and motility, and defecation; Heart- decrease heart rate; Eye- miosis (constriction)?
Cholinergic muscarinic receptors.
Nicotinicn Nicotinicm and muscarinic are three subtypes of which types receptors?
Cholinergic receptors.
What drug class is used to treat an overdose of anticholinergic or antimuscarinic agents?
Cholinesterase inhibitor such as physostigmine
Tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne formerly called Reminyl) are drugs used to treat AD? All increase levels of ACh and are known as ___________________?
Cholinesterase inhibitors
What drug is associated with tendon rupture?
Ciprofloxacin (Cipro) and other fluoroquinolones
What can ciprofloxacin do to warfarin (Coumadin) levels?
Ciprofloxacin can elevate warfarin levels
Why is bronchoconstriction worse at night in patients with asthma?
Circadian rhythms occur with increased bronchoconstriction at 2-3 am due to the release of histamine
An elderly patient with prolongation of the QT interval will need a decreased dose of________?
Citalopram
Which antidepressants are recommend in the elderly?
Citalopram, sertraline and venlafaxine
What are the available beta-lactamase inhibitors in the US?
Clavulanic acid, tazobactam, & sulbactam are used in combo with PCN
State the adverse effects of using phenytoin during pregnancy
Cleft palate, heart malformations, and fetal hydantoin syndrome.
Which antibiotic can produce severe AAPMC (which can be fatal) and should only be used for anaerobic infections located outside the CNS?
Clindamycin
Which TCA is approved to treat obsessive compulsive disorder (OCD)?
Clomipramine
Drugs that stimulate the alpha 2 receptors centrally decrease the firing of sympathetic neurons to DECREASE blood pressure. These drugs are considered indirect-acting anti-adrenergic agents and include:
Clonidine Methyldopa
Drugs used to treat ADHD are stimulants and non-stimulants. Which of the following medications are used to treat ADHD and are NOT considered stimulants:
Clonidine (Kapvay) Atomoxetine (Strattera) Guanfacine (Intuniv)
Why is it important to advise patients to avoid hazardous activities while taking clonidine?
Clonidine can lead to CNS depression, drowsiness, and sedation
Clonidine (Catapres) activates the alpha 2 receptors in the CNS to decrease SNS outflow to blood vessels and the heart. The outcome is (increased or decreased) blood pressure?
Clonidine decreases blood pressure.
The difference between opioids and narcotics is that opiods apply to compounds present in opium. Narcotics on the other hand not only include opioids but drugs such as___________________?
Cocaine, marajuana, and LSD.
Give an example of Schedule II drugs
Codeine, fentanyl, hydromorphone, morphine, dextroamphetamine.
The FDA recently provided warnings on the uses of statins and adverse effects including:
Cognitive impairment and memory loss Possible increased risk of diabetes There is no longer a need for monitoring of liver transaminases
What are the signs of opioid overdose?
Coma, respiratory depression and pinpoint pupils
Give an example of an inhaled agent that combines a beta 2 agonist and an anticholinergic agent
Combivent is a combination of albuterol and ipratropium
What is the major indication for using a potassium-sparing diuretic such as spironolactone (Aldactone)?
Common use - to counteract loss of potassium when loop or thiazide diuretic used. Approved for heart failure
What is the major indication for using a potassium-sparing diuretics such as spironolactone (Aldactone)?
Common use, to counteract loss of potassium with loop or thiazide diuretics. Approved for heart failure
What is the Black Box Warning that all opiates have in common?
Concomitant opioid use with other CNS depressants, including alcohol and BZDs can cause profound sedation, respiratory depression and death.
Can fibric acid derivatives (fibrates) and statins be used together?
Concurrent use increases risk of statin induced myopathy. Use great caution.
What does widening of the QRS signify?
Conduction through the ventricles is slowed. Warning for impending torsades
Methylnatrexone (Relistor) is a selective mu opioid antagonist indicated for opioid-induced________________?
Constipation
Opioids stimulate mu receptors in the gut suppressing propulsiveintestinal contractions leading to_______________?
Constipation
When the baroreceptor reflex is activated in response to low blood pressure the arterioles (dilate or constrict) and the heart rate (increases or decreases)?
Constrict and increase
When the baroreceptors reflex is activated in response to low blood pressure the arterioles (dilate or constrict) and the heart rate (increases or decreases)?
Constrict and increase
Blocking beta 2 receptors by giving a beta antagonist (beta blocker) would cause (dilation or constriction) of bronchi?
Constriction
Hypersensitivity
Continuous exposure to antagonists can result in hypersensitivity (aka supersensitivity)
What are the two major groups of drugs used to treat psychosis?
Conventional (first generation) and atypical (second generation) antipsychotics.
Of the conventional and atypical antipsychotics, which one has more extrapyramidal symptoms (EPS)?
Conventional or first generation antipsychotics such as haloperidol (Haldol) have more EPS symptoms
Why do 75% of older adults intentionally stop taking their medications?
Cost.
Codiene is extremely effective at lower doses to suppress_________?
Cough
When ACE is blocked, Kinase II is also blocked. Kinase breaks down bradykinins. When Kinase II is blocked, bradykinins build up and lead to edema. Bradykinins promote dilation and its buildup is thought to cause a dry_______ in patients taking ACE inhibitors?
Cough
What are some helpful nondrug measures for treatment of schizophrenia?
Counseling, behavioral therapy, vocational training, and therapeutic relationship
What laboratory tests need to be done prior to the initiation of any azole antifungal agent?
Creatine clearance and liver function tests
Creatinine Clearance
Creatinine levels do not adequately reflect kidney function in older adults because the source of serum creatinine—lean muscle mass—declines in parallel with the decline in kidney function.
What is the name of the enzyme required by platelets to synthesize thromboxane A2 (TXA2) which is one of the factors that promote platelet activation.
Cyclooxygenase
What drug can increase the levels of ezetimibe?
Cyclosporine
List the agents that inhibit CYP3A4 and can raise the levels of some statins.
Cyclosporine, macrolide antibiotics, azole antifungals, & protease inhibitors.
Atenolol is classified as pregnancy category _________?
D (this classification is no longer used)
How is antibiotic-associated pseudomembranous colitis (AAPMC) treated?
D/C offending agent and start oral vancomycin or metronidazole
What are some of the recommended oral agents to lower urgent HTN?
DHP CCBs, combinations ACE or ARB, CCBs, clonidine, & labetalol
What is the difference between MDIs and DPIs?
DPIs (dry powder inhaler) deliver drugs in the form of a dry, micronized powder directly to the lungs. New delivery devices are environmentally friendly.
Anticoagulant not used in patients with artificial heart valves
Dabigatran and other NOACs
Why is it important to monitor for s/s of thrombosis when a patient is suspected of having HIT from administration of heparin?
Damage to endothelium causes clumping of ineffective platelets and thrombosis.
What is the agent of choice for treating maglinant hyperthermia?
Dantrolene
What is the name of the drug used to treat malignant hyperthermia?
Dantrolene
Why are elderly patients at increased risk of side effect and AE with analgesics?
Decline in hepatic metabolism and renal excretion
Why would it be important to check cholesterol levels in women reaching menopause?
Declining estrogen levels occurring in menopause lead to increases in LCL-C and a decline in HDL-C. Otherwise cholesterol levels are mostly stable throughout the lifespan unless there are changes in dietary intake and excessive weight gain.
A drug that blocks alpha 1 receptors (alpha antagonist) would be used to (increase or decrease) blood pressure?
Decrease
A drug that blocks alpha 1 receptors (alpha antagonist) would be used to (increase or decrease) blood pressure?
Decrease
By an unknown mechanism, thiazide diuretics (increase or decrease) peripheral vascular resistance to lower blood pressure?
Decrease
Cholinergic drugs such as donepezil (increase or decrease) heart rate?
Decrease
Phenytoin and other AEDs stimulate synthesis of hepatic drug-metabolizing enzymes. As a result, phenytoin can (increase or decrease) the effects of other drugs such as oral contraceptives, warfarin, and glucocorticoids?
Decrease
St John's Wart is an inducing agent and can (increase or decrease) the efficiacy of other drugs?
Decrease
A patient taking Coumadin is prescribed phenytoin. With this combination the INR would be expected to (increase or decrease)?
Decrease because the levels of Coumadin would be decreased
What are the possible consequences to the fetus if diuretics are taken during pregnancy?
Decrease in placental perfusion, nutrition and growth retardation
What is the most important cause of drug reactions in the elderly?
Decrease in renal excretion. Renal function declines in all individuals starting at about age 40.
What lifestyle measures can reduce triglycerides?
Decrease intake of carbohydrates and alcohol
Phenytoin and other AEDs induce hepatic drug-metabolizing enzymes. As a result, phenytoin and other AEDs can:
Decrease the effects of other drugs
High protein meals (increase or decrease) absorption of levadopa?
Decrease. Absorption of levadopa declines in the presence of high protein.
Anticholinergic drugs are used in Parkinson's disease block muscarinic receptors to (increase or decrease) ACh which restores the balance between dopamine and ACh?
Decrease. By restoring the balance between ACh and dopamine.
PPIs can (increase or decrease) the antiplatelet effect of clopidogrel?
Decrease. In addition, some individuals are unable to metabolize clopidogrel into its active form rendering it inactive
Rifampin is an inducer and can (increase or decrease) the effectiveness of warfarin, oral contraceptives, and HIV drugs.?
Decrease. Increased metabolism of these drugs may require higher dose
Centrally acting anticholinergic drugs used in Parkinson's disease block muscarinic receptors to (increase or decrease) Ach?
Decrease. Symptoms of PD are improved when ACh is blocked.
Phenytoin can (increase or decrease) the synthesis of vitamin K dependent clotting factors in the newborn.
Decrease. Vitamin K may need to be given at term to prevent bleeding
Beta blockade leads to (increased or decreased) heart rate?
Decreased
If a patient is taking an oral hypoglycemic and TMP/SMZ (Bactrim) the blood sugar may be elevated or decreased?
Decreased
In patients with "loss of function" of the PCSK9 protein, LDL-C levels are (increased or decreased)?
Decreased
Older adults require (increased or decreased) dosages of opoids?
Decreased
Rifampin and certain antiepileptic drugs induce metabolizing enzymes and when used with protease inhibitors the effectiveness of the protease inhbitiors are:
Decreased
Which situations cause renin to be released from the kidneys?
Decreased BP, blood volume, plasma sodium content or renal perfusion pressure
Accelerated metabolism would lead to (increased or decreased) blood levels of other drugs?
Decreased blood levels.
Activation of alpha 2 receptors decreases sympathetic outflow to the heart and blood vessels which leads to (increased or decreased) blood pressure?
Decreased blood pressure.
List the causes of hypokalemia
Decreased intake, diuretics, excessive sweating, increased insulin, alkalosis
List the causes of hypokalemia.
Decreased intake, diuretics, excessive sweating, increased insulin, alkalosis
Drugs last longer in the elderly due to (decreased or increased) liver function?
Decreased liver function. Not all elderly individuals have decreased liver function.
What effects do opioids have on patients with increased intracranial pressure (ICP)?
Decreased respiratory rate can lead to build up of CO2= brain edema.
Define tolerance.
Decreased responsiveness to a drug as a result of repeated drug administration.
Drug metabolizing capacity in infants is (decreased or increased)?
Decreased.
Patients with Alzheimer's disease (AD) have reduced cholinergic transmission and (decreased or increased) levels of acetylcholine?
Decreased. Levels of ACh are found to be diminished in patients with AD
List the adverse effects of furosemide (Lasix).
Decreases electrolytes sodium, chloride, potassium, hypotension, dehydration
How does Nesiritide (Natrecor) help patients in HF?
Decreases preload and afterload by dilating veins and arteries, however, mortality may increase
The atypical antidepressant Wellbutrin (bupropion) is used for smoking cessation. It is contraindicated for patients with seizure disorder because it (increases or decreases) the seizure threshold?
Decreases. Bupropion increases the risk of seizures by decreasing the seizure threshold.
Activation of alpha 2 receptors in the CNS (increase or decreases) sympathetic outflow to the blood vessels and the heart and (increases or decreases) blood pressure and heart rate.
Decreases; Decreases
Activation of alpha 2 receptors in the CNS (increase or decreases) sympathetic outflow to the blood vessels and the heart and (increases or decreases) blood pressure and heart rate?
Decreases; Decreases
Beta blockers reduce angina pain primarily by (increasing or decreasing) cardiac oxygen demand. This is done by blocking beta 1 receptors in the heart, which decrease HR and contractility.
Decreasing
By decreasing preload, venous dilators cause an increase or decrease in cardiac work?
Decreasing preload causes cardiac work to decrease.
What is the primary pathology in Parkinson's disease and how is it treated
Degeneration of neurons, resulting in an imbalance between dopamine and ACh.
Why is diarrhea a problem in a patient taking lithium?
Dehydration and decreased sodium can cause increased lithium levels.
What are some of the characteristics of schizophrenia?
Delusions, hallucinations, and disordered thinking
How long is treatment given for H-pylori eradication?
Depending on the drug combination used, 10-14 days.
ECT, transcranial magnetic stimulation, vagus nerve stimulation, and light therapy are non drug therapies for _____________
Depression
Reserpine (adrenergic neuron blocker) decrease norepinephrine (NE) in order to decrease blood pressure. The reduction of NE can lead to severe_____________?
Depression. Reserpine is rarely used. The MOA of reserpine is important in order to understand the monoamine hypothesis of depression which links a deficiency of neurotransmitters with the cause of depression
Downregulation
Desensitizing occurs when the receptors of a cell are continually exposed to an agonist (molecules that activate receptors or drugs that mimic the body's response) the cell becomes less responsive.
Recently, the FDA made a change on how it classifies drug risk in pregnancy. What is the change?
Details are provided and the A-X are not longer used.
The Edinburgh Scale is used for________?
Detection of depression after a woman gives birth.
A patient presents with agitation, anxiety, hallucinations, myoclonus, and hyperreflexia. The nurse suspects serotonin syndrome. Which of the following drugs can contribute to serotonin syndrome?
Detromethorphan Meperidine Sumatriptan Venlafaxine Amytriptyline
What is the difference between dexamethasone and prednisone?
Dexamethasone is long acting
What is the name of the non-opioid anti-tussive preparation that decreases cough?
Dextromethorphan
What is the name of the non-opioid preparation that decreases cough?
Dextromethorphan
What population of patients would need a longer course of antibiotics for treatment of UTI?
Diabetics, men, young children, pregnant woman, & complex UTIs
Drugs used for treatment of AD prevent the breakdown of ACh increasing the availability of ACh at cholinergic synapses. Which of the the following are cholinergic responses?
Diarrhea Nausea Bradycardia Bronchoconstriction
What drug might be used to treat lidocaine-induced convulsions?
Diazepam (BZD) and phenytoin.
Initial control of convulsive status epilepticus is accomplished with intravenous:
Diazepam or lorazepam
Describe the principles of the DASH diet.
Diet rich in fruits, vegetables, and low fat dairy products (high levels of calcium and potassium)
Which drugs are approved for short term weight loss (3 or more months)?
Diethylpropion and phenrermine (Adipex)
Hypokalemia caused by high ceiling diuretics such as furosemide can be a special problem for patients taking which of the following drugs?
Digoxin
Amplodipine
Dihydropyridine calcium channel blocker
The primary effect of the _________ are to block calcium channels in blood vessels which cause vasodilation then reduces blood pressure with minimal blockade of calcium channels in the heart.
Dihydropyridines such as amlodipine
The primary effect of the________ are to block calcium channels in blood vessels which cause vasodilation that reduces blood pressure with minimal blockade of calcium channels in the heart.
Dihydropyridines such as amlodipine.
Hypotension, flushing, headache, dizziness, peripheral edema, gingival hyperplasia, reflex tachycardia (with nifedipine) are side effects of_______?
Dihydropyridines such as nifedipine (Procardia) and amlodipine (Norvasc).
Vasodilators that dilate capacitance vessels (veins) increase or decrease preload?
Dilating veins causes a decrease in preload.
Activation of beta 2 receptors leads to bronchial (constriction or dilation)?
Dilation
Why do CCBs sometimes lead to peripheral edema?
Dilation occurs in the arterioles and not in the veins leading to a mismatch which causes increased hydrostatic pressure on the arterial side and fluid leak
The non dihydropyridines can slow the heart rate. Two examples of non-dihydropyridines are _______?
Diltiazem and verapamil.
How should vancomycin be administered?
Diluted in minimum of 250 ml and administered over 90 minutes
Which of the following antihistamines would provide the greatest amount of sedation?
Diphenhydramine (Benadryl)
Dabigatran (Pradaxa)
Direct Thrombin Inhibitor
What is DOT?
Direct observation therapy (DOT) to ensure compliance and minimize resistance
Which new drug class lowers blood pressure by decreasing the production of angiotensin directly?
Direct renin inhibitor (DRI) aliskiren (Tekturna)
causes of occult volume overload that can lead to resistant HTN
Direct vasodilators can cause compensatory expansion of ECF volume. Excessive salt intake and progressive renal insufficiency are other causes
Aliskiren (Tecturna) is a new class of antihypertensive drugs. It lowers blood pressure by_______:
Directly inhibiting renin
Oxidation of catecholamines over time causes color changes and these solutions should be ____________?
Discarded
Oxidation of catecholamines over time causes color changes and these solutions should be___________?
Discarded
What is the treatment for statin induced myositis?
Discontinue the statin, hydration, and draw CK levels.
What are the cognitive symptoms of schizophrenia?
Disordered thinking, reduced ability to focus attention, and prominent learning and memory difficulties.
What is the etiology of BPD?
Disruption of neuronal growth and survival or imbalance of neurotransmsitters
What is the reaction that occurs when metronidazole and alcohol are ingested?
Disulfiram reaction with severe gastrointestinal symptoms
Which class of antihypertensive drugs are recommended in African Americans (AAs)?
Diuretics and CCBs are first line antihypertensive drugs due to low renin in AAs.
Which class of antihypertensive drugs are recommended in African Americans?
Diuretics are first line antihypertensive drugs, CCB's second line.
Why should patients with gout avoid diuretics?
Diuretics can increase uric acid levels to precipitate a gouty attack
Should women who are breastfeeding take diuretics?
Diuretics enter breast milk and can be hazardous t the nursing infant
Why are thiazide diuretics considered "first-line" for treatment of stage-one hypertension?
Diuretics have been shown to be effective in decreasing morbidity and mortality, and they are inexpensive. JNC-8 lists 4 agents as first line
Which drug classes are used to treat HF?
Diuretics, RAAS blockers, BBs, digoxin, neprilysin inhibitors (sacubitril) and isosorbide dinitrate/hydralazine (BiDil)
Are there indications to use ACE inhibitors and ARBs together?
Do not use these 2 agents together.
What is the problem with the Framingham Risk Calculator?
Does not calculate for age of > 79 years or consider family history or inflammation
Activation of ___________________receptors have the following effects: Dilation of kidney vasculature
Dopamine
Why do drugs that increase dopamine have the potential to cause dysrhythmias?
Dopamine is an amine and these agents stimulate the heart
What are some of the mechanisms that drugs employ to increase dopamine?
Dopamine replacement (levodopa), dopamine agonist (pramipexole), inhibit the breakdown of levodopa (entacapone and rasagline), promote release of dopamine (amantadine)
Levodopa
Dopaminergic
Renal Dosing
Dosing based on kidney function
What can occur when beta-2 agonists are used on a daily basis for asthma symptoms?
Down regulation (diminished and less effective beta-2 receptors)
What is the problem with using B2 agonists on a daily basis?
Down regulation of receptors: decrease in beta2 numbers = diminished response
Desensitizing occurs when the receptors of a cell are continually exposed to an agonist (molecules that activate receptors or drugs that mimic the body's response) the cell becomes less responsive. What is this known as?
Down-regulation.
Which of the following antibiotics can be used in an individual with PCN allergy?
Doxycycline
Describe the clinical manifestations oral BZD overdose.
Drowsiness and lethargy
Baclofen (Lioresal) is used to treat spasticity and works by mimicking the inhibitory actions of GABA. CNS effects include:
Drowsiness, dizziness, weakness, and fatigue
Distribution
Drug movement from the blood to the interstitial space of tissues and from there into cells.
Chemical Equivalence
Drug products contain the same active compound in the same amount and meet current official standards; however, inactive ingredients in drug products may differ.
What happens when two highly protein bound drugs are given together and compete for sites on the protein?
Drug with the weakest attraction becomes "free" and can reach toxic levels.
What is the most common cause of acute liver failure and hepatotoxicity?
Drugs are the leading cause of acute liver failure (hepatotoxicity) in the U.S.
According to the Beers Criteria, which anticholinergic drugs are potentially inappropriate for use in geriatric patients?
Drugs for overactive bladder such a oxybutynin
P450 Enzyme System
Drugs may be P450 substrates, P450 enzyme inducers, or P450 enzyme inhibitors. Often a drug may have more than one property. For example, a drug may be both a substrate and an inducer. Drugs that are metabolized by P450 hepatic enzymes are substrates. The rate at which substrates are metabolized is affected by drugs that act as P450 inducers or inhibitors. A group of enzymes involved in drug metabolism and found in high levels in the liver. These enzymes change many drugs, including anticancer drugs, into less toxic forms that are easier for the body to excrete.
Inhibition
Drugs that act on the liver to decrease rates of drug metabolism are called inhibitors. This process is known as inhibition. These drugs also create therapeutic consequences because slower metabolism can cause an increase in active drug accumulation. This can lead to an increase in adverse effects and toxicity.
Inducers
Drugs that act on the liver to increase rates of drug metabolism
Why should patients on cholinesterase inhibitors avoid anticholinergic drugs?
Drugs that block the cholinergic response cancel out the therapeutic effects of the drugs used for AD
Inhibitors
Drugs that decrease the metabolism of other drugs by inhibiting hepatic enzymes
Enteric
Drugs that have been covered with a material designed to dissolve in the intestine but not the stomach.
Agonist
Drugs that mimic the body's own regulatory molecules
Drugs that depress peristalsis (reduce or increase) absorption?
Drugs that prolong drug time in the intestine increase absorption.
Renal Insufficiency
Drugs to Avoid: Aldosterone blockers Drugs to Use: RAAS blockers
Heart Block
Drugs to Avoid: BB, non DHP CCBs
Dyslipidemia
Drugs to Avoid: BBs, high dose diuretics
Hypokalemia
Drugs to Avoid: Diuretics
OAB
Drugs to Avoid: Diuretics
Gout
Drugs to Avoid: Diuretics Drugs to Use: ARB (losartan)
DM
Drugs to Avoid: High dose diuretics, BBs Drugs to Use: ACEIs and ARBs
Collagen disease
Drugs to Avoid: Hydralazine Drugs to Use: ACEIs and ARBs
Post MI
Drugs to Avoid: Hydralazine Drugs to Use: BB, RAAS blockers
Liver disease
Drugs to Avoid: Methyldopa
Asthma
Drugs to Avoid: Non cardio-selective BBs
Heart Failure
Drugs to Avoid: Non dihydropyridine (DHP) CCBs Drugs to Use: Diuretics, BBs, RAAS blockers
Preeclampsia
Drugs to Avoid: RAAS blockers Drugs to Use: Methyldopa, labetalol
Hyperkalemia
Drugs to Avoid: RASS blockers Drugs to Use: Diuretics
Depression
Drugs to Avoid: Reserpine, BBs (evidence is weak)
Cholinesterase inhibitors
Drugs used to treat myasthenia gravis and Alzheimer disease
Which classes of drugs used with opioids can exacerbate opioid-induced consipation and urinary retention?
Drugs with anticholinergic effects (antihistamines, TCAs, & antipsychotics).
The best reason for changing from an ACE Inhibitor to an ARB is:
Dry cough
The type of inhaler used to treat asthma in the form of a dry, micronized powder inhaled directly into the lungs is called_________?
Dry powder inhaler (DPI)
Why are non dihydropyridine CCBs usually discontinued when patients have heart failure?
Due to negative inotropic effects, they can exacerbate heart failure
Which NSRI has been used to treat pain syndromes such as diabetic neuropathy, can increase BP, and can cause liver damage?
Duloxetine (Cymbalta)
When do symptoms of schizophrenia typically present
During adolescents and early adulthood
When are iron requirements the highest?
During preganancy
When extrapyramidal function is disrupted, disorders of movement can result. These movement disorders are called___________?
Dyskinesias
What are the clinical manifestations of digoxin toxicity?
Dysrhythmias, anorexia, nausea, and vomiting, fatigue and visual disturbances
What is the causative organism in most urinary tract infections (UTI's)?
E-coli is the most common infecting organism
How is an MI diagnosed?
ECG changes (ST elevation), positive troponins, history, and clinical signs.
The dose that is required to produce a defined therapeutic response in 50% of the population is known as what?
ED50.
What is the work up for HF?
EKG, CXR, BNP, ECHO
State the three (3) most important characteristics of any drug.
Effectiveness, safety, and selectivity
Name food sources high in iron
Egg yolks, brewer's yeast, wheat germ, muscle meats, fish, and fowl
The U.S. Preventive Services Task Force recommends screening all adults more than _____________ years of age ____________for HTN?
Eighteen and Annually
Patients over what age account for over 50% of all adverse drug reactions (ADR's).
Elders over the age of 65.
Aldosterone leads to retention of sodium and excretion of potassium and hydrogen. Retention of sodium causes water to be retained which (elevates or lowers) the blood pressure?
Elevates
What is the impact of activation of adrenergic receptors when epinephrine is given for anaphylaxis?
Elevation of BP, suppression of glottal edema, and counteraction of bronchoconstriction
Marcrolide antibiotics are losing favor due to:
Emerging bacterial resistance due to inappropriate use
State the adverse effects of opioid agonists.
Emesis, increased ICP, euphoria, dysphoria, sedation, miosis, & neurotoxcity.
In the PARADIGM study, Entresto was superior to_________?
Enalapril
Which ACEI is available in an IV formulation?
Enalaprilat (Vasotec)
examples of end organ damage occurring in a HTN crisis
Encephalopathy, intracerebral hemorrhage, unstable angina, MI, LV failure with pulmonary edema, eclampsia, stroke, & dissecting aortic aneurysm
The prototype COMT Inhibitor is ___________?
Entacapone (Comtan) which is used with levodopa
Define biotransformation (drug metabolism).
Enzymatic alteration of drug structure.
Biotransformation
Enzymatically mediated alteration of drug structure. the chemical alteration of drug structure. Most drug metabolism takes place in the liver.
What are beta lactamases?
Enzymes made by the bacteria that cleave the beta lactam ring of the antibiotic
What is the principal transmitter released by the adrenal medulla?
Epinepherine
How is a severe allergy to PCN treated?
Epinephrine 1:1000 (0.3 ml) IM, volume support, & airway management
Why are beta blockers problematic in patients with severe allergies?
Epinephrine is the drug of choice and its effect will be diminished in the presence of beta blockers
How is anaphylactic shock treated?
Epinephrine, oxygen, bronchodilator, glucocorticoids, and antihistamines.
Bioequivalent
Equal active ingredients, dosage form, identical disintegration, rate of absorption, efficacy, and safety
Abortive therapy for migraines includes ergotamine. An acute or chronic overdose can lead to ischemia. This serious toxicity is known as:
Ergotism
What is the syndrome of toxicity of ergot alkloids characterized by constriction of peripheral arteries and arterioles in which extremities become cold, pale, and numb muscle pain develops and gangrene may result.
Ergotism.There is a "Black Box Warning for risk of peripheral ischemia. Ergot alkaloids are "second line" drugs for abortive therapy of migraines.
Name the major macrolide antibiotics
Erythromycin (the prototype), clarithromycin, azithromycin, & dirithromycin
Which macrolide is famous for its adverse effects on the GI track and many drug-drug reactions?
Erythromycin-clarithromycin is better tolerated but has similar problems with drug interactions
What is the name of the glycoprotein hormone that stimulates production of RBCs, and is produced in the peritubular cells in the proximal tubules of the kidneys?
Erythropoietin
causes of HTN emergencies
Essential HTN, renal parenchymal disease (vasculitis, acute glomerulonephritis), renal vascular disease, eclampsia, drug elated causes, withdrawal of HTN drugs, pheochromocytoma, Cushing's syndrome, and head injury
Which agent used to treat TB causes optic neuritis (blurred vision, constriction of visual field, and disturbances of color discrimination)?
Ethambutol
What is the drug of choice for treatment of absence seizures?
Ethosuximide (Zarontin)
What is one of the main reasons for opioid abuse?
Euphoria
Name the three most important goals of pre-administration assessment.
Evaluate effects, identify high-risk patients, & assess for self care.
If the lipid panel is normal, what is the recommended frequency to repeat it?
Every five years
What measures can be tried in the event of "statin intolerance"?
Every other day, or once a week dosing with longer acting agents such as rosuvastatin pitavastatin, or atorvastatin may be helpful. Switching to another statin may be helpful and starting with a lower dose. There is no evidence that this dosing regimen provides the same reduction in morbidity and mortality.
Atropine
Example of an anticholinergic drug
What are the adverse effects of having excess amounts of Ach which occurs when the enzyme is blocked that breaks it down (MOA of cholinesterase inhibitors)?
Excessice muscarinc stimulation leads to excessive salavation, increased gastric secretions, increased mobility of the GI tract, urinary urgency, bradycardia, sweating, miosis (Mr. Pathetic)
What are the possible causes of schizophrenia?
Excessive activation for dopamine and insufficient activation of glutamate is postulated
What is the problem with using a beta blocker and a non dihydropyridine CCB concurrently?
Excessive cardio suppression (bradycardia) can occur
What occurs if beta-adrenergic blockers are used with verapamil?
Excessive cardio suppression and bradycardia.
ACh is an (inhibitory or excitatory) neurotransmitter?
Excitatory. ACh stimulates GABA.
What aspect of pharmacokinetics (absorption, distribution, excretion, & metabolism) is affected in patients with kidney disease?
Excretion
Why are drugs with a short half life preferred in older individuals?
Excretion is diminished, so drugs with a long half-life are prolonged and so are adverse effects in older individuals
Which injectable drug used to treat diabetes can promote weight loss?
Exenatide (Byetta) and liraglutide (Victoza)
What lifestyle changes can elevate HDL-C lipids?
Exercise and smoking cessation can elevate HDL lipids.
Choose the true statement regarding trade name medications.
"Double medication" with brand products can be devastating
Treating an infection with an antimicrobial agent using clinical expertise, by knowing which microbes generally cause infections in the affected site (rather than waiting for culture & sensitivity data) is called______________?
"Empiric therapy"
How do you calculate an estimate of creatinine clearance?
(140-age) x weight in kg _________________________ Serum creatinine (mg/dL) x 72)
What are some conditions that can cause elevated LDL levels?
- Chronic kidney disease - Nephrotic syndrome - Obstructive liver disease - HIV infection - Autoimmune disorders - Hypothyroidism - Pregnancy - Polycystic ovary syndrome - Menopause transition
What are the secondary causes of elevated triglycerides?
- End stage renal disease - Nephrotic syndrome - Hypothyroidism - Drugs (steroids, estrogens, progestins, tamoxifen, protease inhibitors, diuretics and beta blockers) - Diabetes (hyperglycemia) - Excessive alcohol - Obstructive liver disease - Excessive intake of carbohydrates
Patients with ASCVD are considered "high risk" and treated aggressively with lipid lowering measures. What conditions are included in the broad term "ASCVD" or clinical ASCVD?
- Myocardial infarction - Stable or unstable angina - Coronary or other revascularization procedure - Transient ischemic attack - Ischemic stroke - Atherosclerotic arterial disease: includes ankle/brachial index of < 0.90
Name a few common drugs that can elevate LDL-C levels
- Some progestins - Anabolic steroids - Danazol - Isotretinoin (Claravis-formerly known as Accutane) - Immunosuppressive drugs (cyclosporine) - Amiodarone - Thiazide diuretics in high doses - Glucocorticoids - Thiazolidinediones - Fibric acids (in severe hypertriglyceridemia) - Long chain omega-3 fatty acids (in severe hypertriglyceridemia if containing docosahexaenoic acid)
What are the non-lipid benefits of statins?
- Stabilization of plaque - Reduction of plaque inflammation - Slowing of coronary calcification - Improvement of endothelial function - Enhancement of the ability of blood vessels to dilate - Reduction of the risk of thrombosis - Inhibition of platelet deposition and aggregation - Possible increase in bone formation - Reduction in the risk of atrial fibrillation
What are the factors that increase the risk for statin myopathy?
-Advanced age especially > 80 years -Female gender -Small body frame, frailty -Multisystem disease (CKD) -Postoperative period -Alcohol abuse -Concomitant medication use (especially cytochrome interactions) -Decreased renal function
What are the FDA recommendations and advice on statins
-They may cause increased risk of diabetes -They may cause memory impairment and cognitive issues -Monitoring of liver changes is no longer recommended -Lovastatin has a lot of drug interactions that can cause muscle damage
A patient having an anaphylactic reaction would use an epinephrine solution concentration of _________% for IM injection.
0.1% or 1:1,000. The adult dose is 0.3 mg and 0.150 mg for a pediatric dose (less than 66 lbs.)
Cholinesterase inhibitors decrease the levels of acetylcholine and are used to treat Parkinson's disease.
False
Extreme elevations in HDL-C are always cardio-protective (true or false)?
False. Some high levels of HDL-C have been found to be non-functional. There are discoveries of various subtypes of HDL-C and this knowledge is still emerging.
Orlistat can cause deficiencies in____________?
Fat soluble vitamins (A, D, E, and K)
What is the potential consequence of a medication that prolongs the QT interval?
Fatal dysrhythmia such as torsade's de pointes
What is the consequence of prolonged use of Dantrolene?
Fatal liver damage
What are the adverse effects of orlistat (Xenical)?
Fecal urgency, possible liver damage
What are the goal HDL levels in men and women?
Females >60 mg/dl. Males >40 mg/dl.
Name the individuals that may have normally elevated BNPs.
Females, older adults, and patients with renal disease
Which of the fibric acid derivatives is approved for use with statins?
Fenofibric acid (TriLipix)
Growth deficiency, motor or mental deficency, microcephaly, craniofacial disorder, postional deformities of the limb, hypoplasia of the nails and fingers and impaired neurodevelopment are all features that can occur with the use of AEDs and is known as______________?
Fetal hydantoin syndrome.
Which drug class is the most effective for lowering triglycerides?
Fibric acid derivatives (fibrates)
What drug elevates neutrophil counts in cancer patients and is used for the treatment of chronic severe neutropenia?
Filgrastim (Neupogen)
How long is the treatment for active TB?
First 2 months 4 drugs and the last 4 months with 2 drugs
Which of the following statements are true regarding alpha adrenergic antagonists (alpha blockers)?
First dose hypotension can occur Concurrent use with erectile dysfunction drugs can cause severe hypotension Floppy iris syndrome can occur making ocular surgery a challenge
State the adverse effects of ACE inhibitors.
First dose hypotension, ace induced cough, hyperkalemia, angioedema.
These antihistamines are highly sedating because they cross the blood brain barrier
First generation antihistamines
Certain drug classes block dopamine and can cause extrapyramidal side effects similar to the movement disorders seen with PD. Which drug class causes these side effects?
First generation antipsychotics
How are beta blockers categorized?
First generation-nonselective; second generation-cardio-selective; and third generation beta blockers with vasodilation actions
What is the name of the reversal agent used to treat BZD overdose?
Flumazenil (Romazicon)
The CDC recommends ceftriaxone (Rocephin) 250 mg IM x1 or cefixime (Suprax) 400mg po x1 for treating gonorrhea because of its resistance to ___________?.
Fluoroquinolones
Which antibiotics cannot be taken with compounds that contain aluminum or magnesium antacids, iron salts, zinc salts, sucralfate, milk and dairy products?
Fluoroquinolones and tetracyclines
Which SSRI has the longest half life and is considered "energizing"
Fluoxetine (Prozac)
Which of the SSRIs is known to be "energizing" and has the longest half-life?
Fluoxetine (Prozac)
What occurs with simultaneous use of lithium and fluoxetine (Prozac)?
Fluoxetine (Prozac) can elevate levels of lithium.
What are the most common adverse effects of nicotinic acid (niacin) used to lower LDL-C levels, triglycerides and elevate HDL-C levels?
Flushing of the skin, hepatotoxicity, and GI upset.
Which of the following agents provides the most robust antiinflammatory effect for the treatment of asthma:
Fluticasone
What are the components of Advair?
Fluticasone (ICS) and salmeterol (a long acting inhaled beta -2 agonist)
What are the components that make up Advair?
Fluticasone (glucocorticoid) and salmeterol (a long-acting, beta2 agonist)- note, salmeterol has black box warning.
Can an allergic reaction occur without prior sensitization to the immune system?
For an allergic reaction to occur there must be prior sensitization.
Estimated (eGFR)
For eGFR in women, multiply equation by 0.85. Normal GFR is greater than 90 mL/min in women and greater that 100 mL/ min in men. (140-age) x weight in kg / Serum creatinine (mg/dL) x 72 (85 for women)
When is only one drug (isoniazid) used as monotherapy for TB?
For latent TB (asymptomatic patients with a positive PPD)
When are oral glucocorticoids used in the treatment of asthma?
For rapid effect
How do you calculate target heart rate?
For vigorous exercise, aim for a target heart rate of 70 to 85 percent of your maximum heart rate (MHR). Your MHR (roughly calculated as 220 minus your age) is the upper limit of what your cardiovascular system can handle during physical activity.
How target heart rate is calculated
For vigorous exercise, aim for a target heart rate of 70 to 85 percent of your maximum heart rate (MHR). Your MHR (roughly calculated as 220 minus your age) is the upper limit of what your cardiovascular system can handle during physical activity.
There are about 7 triptans on the market and some individuals have a better response to one over another. In addition, the half-life varies among these agents. If a patient has migraines that last for a long duration, they would benefit from_________ because it has a very long half-life.
Frovatriptan (Frova)
How long would you expect to have to wait before seeing a full therapeutic effect upon inititation of levodopa for PD?
Full therapeutic responses may take several months to develop.
What is onychomycosis?
Fungal infection of the nails
A patient with an estimated GFR of 10 mL/min/1.73 m3 is in need of a diuretic. Which of the following would be selected?
Furosemide (Lasix)
Which of the following diuretics can cause hyperuricemia and precipitate gouty arthritis:
Furosemide (Lasix) HCTZ Chlorthalidone
When there is a deficit of dopamine, the excitatory influence of ACh goes unopposed causing excessive stimulation of the neurons that release ____________?
GABA. Dopamine inhibits GABA. Too much GABA leads to movement disorders.
What are the gastrointestinal cholinergic side effects that occur with cholinesterase inhibitors?
GI effects include nausea, vomiting, dyspepsia and diarrhea.
Why is montelukast (Singular) given at night?
GI effects may not be noticed if the patient is sleeping
Gemfibrozil (Lopid) increases biliary cholesterol saturation. This can lead to the fomation of_________________?
Gallstones
Gemfibrozil (Lopid) increases biliary cholesterol saturation. This can lead to the formation of_________________?
Gallstones
Mirapex (pramipexole) increases dopamine and can lead to compulsive behaviors such as_______?
Gambling, shopping, eating......
To minimize the adverse effects of inhaled glucocorticoids, patients should be advised to do the following to reduce drug deposition in the oropharynx that may lead to oral candidiasis.
Gargle and employ a spacer device if indicated.
What types of procedures can cause malabsorption of iron and other nutrients?
Gastric bypass surgery for weight loss
Can patients with elevated liver transaminases be treated with statins?
Gastroenterologists have found that in patients with elevated liver transaminases due to nonalcoholic fatty liver, statins can lower the elevated transaminases and improve the fatty liver condition.
Enteral
Gastrointestinal [GI] tract
Patients with elevated LDL-C and triglycerides may need dual therapy with a fibrate and a statin. Which fibrate should not be used with a statin due to an increase risk of adverse effects?
Gemfibrozil (Lopid)
What is the prototype in the fibrate category?
Gemfibrozil (Lopid)
What happens when gemfibrozil and warfarin are used together?
Gemfibrozil displaces warfarin from albumin increasing the anticoagulant effect
Absence seizures are (partial or generalized seizures)?
Generalized
A seizure in which the activity is conducted throughout both hemispheres is known as a _______________seizure?
Generalized seizure
Equal active ingredients, dosage form, identical disintegration, rate of absorption, efficacy, and safety are features of what type of drugs?
Generic bioequivalent drugs.
Polymorphism
Genetic differences at the drug receptor making drug efficacy and toxicity vary
Which antibiotic, when combined with furosemide (Lasix), can potentiate hearing loss?
Gentamycin (aminoglycoside antibiotic)
Why is it important to recommend regular dental care in patients on an AED?
Gingival hyperplasia is common and can be very problematic.
State the major adverse effects of phenytoin.
Gingival hyperplasia, skin rash, dysrhymias and hypotension.
Dietary supplements can have adverse effects and drug interactions the same as medications approved by the FDA. Which of the following can interfere with coagulation:
Ginkgo biloba Garlic Ginger root
Where is SQ heparin administered?
Give in the fatty layer of the abdomen away from the umbilicus rotating sites.
How is intravenous phenytoin administered?
Give slowly in dilute saline no more that 50 mg/min to avoid CV collapse.
How would you administer a drug "on an empty stomach"?
Give the drug either 1 hour before meals or 2 hours after meals.
Heparin
Given subcutaneously or intravenously This drug has a rapid onset Used in pregnancy Block thrombin or factor Xa
Give examples of patients with CKD other the DM that benefit from ACEI/ARBSs.
Glomerular, hypertensive nephrosclerosis patients , and patients with tubulointerstitial disease (SLE)
Drugs that reduce the symptoms of asthma by suppressing inflammation, decreasing synthesis and release of inflammatory mediators, decreasing infiltration and activity of inflammatory cells, decreasing edema in the airway mucosa, and. increasing number of beta-2 receptors are called_________?
Glucocorticoids
Inhaled glucocorticoids are very safe and highly effective in the treatment of asthma because they have minimal adverse effects and _________?
Go directly to the target area
Thick, mucopurulent, and irritating discharge is most likely caused by _______?
Gonorrhea (GC) or Chlamydia
What are the potential consequences when calcium channel blockers are taken with grapefruit juice?
Grapefruit juice inhibits the metabolism of the CCBs leading to hypotension and possibly toxicity
What are the GI adverse effects with orlistat?
Greasy, oily, fecal leakage
Iron supplementation can cause diarrhea or constipation and turn the stool _____________ in color?
Green or black
Why might a growing child require a higher dose than an adult?
Growing children have increased metabolism and sometimes require higher dosages of medication. A good example is levothyroxine which is often prescribed at higher doses than in adults.
What mucolytic agent (expectorant) is prescribed to helps liquify secretions making it easier to expel?
Guaifenesin
Which drugs are alpha2 adrenergic agonists and are approved to treat ADHD?
Guanfacine and clonidine
What are the endocrine effects of clonidine?
Gynecomastia and impotence
What are the neuroendocrine side effects of antipsychotic agents?
Gynecomastia, galactorrhea, and menstrual irregularities
What are the antiandrogenic effects of cimetidine?
Gynecomastia, reduced libido, and impotence.
What is the gram-negative organism is associated with peptic ulcer disease (PUD)?
H. pylori
State other factors that may lead to PUD
H. pylori, NSAIDS, gastric acid, pepsin, and smoking.
What type of lipoprotein participates in "reverse transport" moving LDL-C back to the liver?
HDL-C
What is the new term for patients in heart failure that have preserved EF?
HFpEF The "p" stands for preserved (formally called diastolic heart failure)
What is the potentially fatal immune-mediated disorder associated with the use of heparin that is characterized by reduced platelet counts and a paradoxical increase in thrombotic events?
HIT (heparin induced thrombocytopenia).
What test is recommended in patients of Asian decent prior to treatment with phenytoin or carbamazepine?
HLA-B* 1502
What test is done before beginning treatment with abacabir to assess for hypersensitivity?
HLA-B*5701
Which class of drugs increases the number of LDL receptors in hepatocytes, inhibits hepatic HMG-CoA reductase (the rate limiting enzyme in cholesterol biosynthesis), lowers LDL, increase HDL, slows the progression of CHD, and decreases the risk of stroke, hospitalization, PVD and death?
HMG-CoA reductase inhibitors (statins)
Which class of drugs are the most effective for lowering LDL-C and reducing morbidity and mortality associated with ASCVD?
HMG-CoA reductase inhibitors also known as "statins" becasue of the common ending
Ma Huang (ephedra) has been banned from the US since 2004. It is still available in traditional Asian medicines. What is the problem with this supplement?
HTN, stroke, MI and death
What are the "positive" symptoms of schizophrenia?
Hallucinations, delusion, agitation, tension, and paranoia.
State the adverse effects of nitroglycerin.
Headache, hypotension, & reflex tachycardia- secondary to vasodilation.
What are the symptoms of impending vestibular damage to the ears?
Headache, nausea, unsteadiness, dizziness, and vertigo
Dehydration from diuretic use can promote thromboembolism. Describe the symptoms of thromboembolism.
Headache, pain in chest, calves or pelvis, positive Homan's sign, erythema
Beta1 receptors are located in the:
Heart
Abnormal BNP levels indicate which disease process:
Heart failure
Oral sympathomimetics like pseudoephedrine (Sudafed) produce vasoconstriction, CNS excitation, and cardiovascular stimulation and should not be used with patients with __________?
Heart problems and HTN
What is the response to activation of beta1 receptors in the heart and kidney?
Heart rate increases & kidneys release renin with beta 1 receptor activation.
What is the response to activation of beta1 receptors in the heart and kidney?
Heart rate increases & kidneys release renin with beta 1 receptor activation. Increased rate, force of contraction, and AV conduction velocity Renin release -RA
What does renin do to angiotensinogen?
Helps convert angtiotensinogen into angiotensin I
What routine labs should be ordered in order to assess for cardiovascular disease, evaluate end-organ damage and search for secondary causes of HTN?
Hematocrit, urinalysis, CMP (glucose, creatinine, electrolytes), fasting lipid panel, TSH and EKG
A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency that takes aspirin or a sulfonamide is at risk for what disorder?
Hemolysis (red blood cell destruction).
Which anticoagulant is used during pregnancy and to treat pulmonary embolism (PE), DVT, and MI ?
Heparin
Which anticoagulant suppresses coagulation by helping antithrombin inactivate clotting factors, primarily thrombin and factor Xa?
Heparin
Thrombocytopenia, uncontrollable bleeding, before and after surgery of eye, spinal cord, and brain, lumbar puncture and regional anesthesia, severe liver or kidney disease, hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe HTN, and threatened abortion are all contraindications for the administration of________?
Heparin and other anticoagulants
Describe the adverse effects of valporic acid (Depakote).
Hepatotoxicity, pancreatitis, weight gain, and teratogenic effects.
The risk of tardive dyskinesia is equal with high and low potency first generation antipsychotics. The risk of extrapyramidal symptoms is greater with (low or high) potency first generation antipsychotics.
High
What impact do high triglyceride levels have on HDL-C?
High levels of triglycerides impair and lower the levels of HDL-C
Why are highly lipid-soluble drugs absorbed more rapidly than low lipid soluble drugs?
High lipid-soluble drugs cross membranes that separate them from the blood.
What is the initial impending sign of cochlear damage?
High pitched tinnitus
Haloperidol
High potency first generation antipsychotic
Neuroleptic malignant syndrome presents with "lead pipe" rigidity and sudden high fever. This rare reaction occurs more commonly with:
High potency first generation conventional antipsychotics
Why is non-HDL-C so important?
Higher levels of triglycerides and VLDL decrease the size of the LDL-C. When LDL particles are small and dense they are better able to enter the arterial wall and enhance atherogenesis.
Are highly lipid-soluble drugs absorbed more (rapidly or slowly) than drugs whose lipid solubility is low?
Highly lipid-soluble are absorbed more rapidly than low lipid-soluble drugs.
What can occur when two highly protein bound drugs are given together?
Highly protein bound drugs when given together compete for sites on the protein.
What are the 2 types of histamine receptors?
Histamine-1 receptors mostly in the skin and lungs and histamine-2 receptors mostly in the GI tract
How is asthma diagnosed in young children?
History and physical exam.
What are the contraindications for using ARNIs?
History of hypersensitivity to ACEI or ARB, use of concurrent ACEI or ARBs or DRI, pregnancy and history of angioedema
What comorbid conditions would be indications for a beta blocker?
History of myocardial infarction, angina, palpitations, essential tremor, migraines, & hyperthyroidism.
What are the three most common causes of fatal medication errors?
Human factors, communication mistakes, and name confusion.
Which vasodilator can cause systemic lupus erythematous-like syndrome?
Hydralazine
Why are patients with diabetes considered "high risk" for ASCVD?
Hyerglyceia accelerates the process of atherosclerosis. Patients with DM often succumb to death due to cardiovascular events
Why is hyperglycemia such a problem in respect to ASCVD?
Hyperglycemia inflames the vasculature and accelerates the process of atherosclerosis
A patient with heart failure is prescribed lisinopril and spironolactone. The nurse should be concerned about:
Hyperkalemia
The electrolyte abnormality associated with aldosterone blockers is ____________?
Hyperkalemia
Use of ARNI with aldosterone blockers may lead to____________?
Hyperkalemia
What are the adverse effects of DRIs?
Hyperkalemia, cough, angioedema and diarrhea
What electrolyte abnormality is associated with the use of ACE inhibitors?
Hyperkalemia. When aldosterone is blocked, potassium is retained.
Which percussion note would be found in a patient with asthma?
Hyperresonance
Levodopa and MAOIs can lead to (hypertension or hypotension)?
Hypertension
Which of the following co-morbid conditions would prevent the provider from selecting a triptan for a patient with migraine headaches?
Hypertension Hyperlipidemia Pregnancy
What are the major adverse effects when using epotin alpha?
Hypertension and an increase in myocardial events
Use of sulfonylurea and azole antifungals can lead to (hypoglycemia or hyperglycemia)?
Hypoglycemia
What should you be aware of when treating patients with diabetes that are taking sulfonamides such as TMP/SMZ (Bactrim)?
Hypoglycemia can occur
A patient with pernicious anemia is receiving cyanocobalamin. What electrolyte imbalance can occur?
Hypokalemia
What electrolyte imbalance is associated with cyanocobalamin (B12) therapy?
Hypokalemia
Azithromycin and certain FQ should be avoided in patients with pro-arrhythmic conditions that can increase the risk of torsades de pointes. What are some of these conditions?
Hypokalemia, hypomagnenesemia, bradycardia or use of Class 1A and Class III antiarrhythmic agents.
Which of the following electrolyte imbalances would be problematic in a patient treated with lithium?
Hyponatremia
Why is it important to check electrolyte levels in patients taking SSRI's?
Hyponatremia can occur
Which electrolyte abnormality can be seen rarely with SSRIs?
Hyponatremia. When diuretics are used with SSRIs, the risk of hyponatremia is increased.
PDE5 phosphodiesterase type 5 inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are drugs used for erectile dysfunction. When combined with nitroglycerin they can cause life threatening _________________?
Hypotension
What is biggest concern with the use of clonidine?
Hypotension
Which of the following are adverse effects of opioid analgesics:
Hypotension Increase in intracranial pressure Constipation Euphoria
PDE5 inhibitors are effective in men with ED. Which of the following are adverse effects?
Hypotension when used with nitrates and alpha blockers Priapism Hearing and vision loss
What are the principle adverse effects of clonidine?
Hypotension, bradycardia, sedation and xerostomia (dry mouth)
Morphine-like drugs blunt the baroreceptors reflex and dilate peripheral arterioles and veins leading to_______________?
Hypotension. Antihypertensive medications may need to be decreased.
Adverse effects of lithium when levels are therapeautic include; GI upset, fatigue, muscle weakness, tremorheadache, polyuria, renal toxicity, goiter, and (hyperthyroidism or hypothyroidism)?
Hypothyroidism.
Name factors that may alter automaticity or conduction in the heart.
Hypoxia, electrolyte imbalance, reduced coronary blood flow, MI, antidysrhythmic drugs.
A patient admits to using their albuterol inhaler 4-5 times weekly and is therefore categorized with mild persistent asthma. The preferred treatment for this patient is to add:
ICS
What is the advantage of using inhaled (rather than oral) glucocorticoids in the treatment of asthma?
ICS treat the target area when inhaled and have minimal adverse effects.
Can inhaled glucocorticoids be used for rescue of asthma symptoms?
ICSs are used for prophylaxis of asthma symptoms, not for rescue.
Drugs used to treat ADHD are Schedule _________. Refills are not permitted. Patients must have a hard copy of the prescription each month
II
Most all opioid agonist are Schedule_________?
II
Timothy is in HF due to valvular dysfunction. He is limited in his ability to complete activities of daily living and has dyspnea when he gets up to go to the bathroom. He also gets SOB talking. What stage NYHA is he in?
III-IV
What can happen to the INR when warfarin and orlistat are used together?
INR can rise because vitamin K is decreased
If a patient is taking warfarin (Coumadin) and TMP/SMZ (Bactrim) the INR might increase or decrease?
INR may increase and lead to bleeding
Which of the following drugs can worsen heart failure:
Ibuprofen Antidysrhythmics Naprosyn Verapamil Diltiazem Pioglitazone (Actos)
Which of the following medications can attenuate the the effects of diuretics?
Ibuprofen and other non steroidal anti-inflammatory drugs (NSAIDs)
Some patients with genetic alterations have persistent paralysis after the use of succinylcholine (a neuromuscular blocking agent). The inability to degrade succinylcholine is an_________________reaction
Idiosyncratic reaction.
Why is it important to assess for mood instability before treating a patient for depression?
If a patient has BPD and is started on an antidepressant such as an SSRI, mania can be precipitated
When should you move from an ACEI to an ARB?
If the patient has a cough
When is the best time to take a medication if breast feeding?
Immediately after breast feeding.
A consequence of using an alpha antagonist might have what effect on sexual function?
Impotence, failure to ejaculate, and erectile dysfunction
A consequence of using an alpha antagonist might have what effect on sexual function?
Impotence, failure to ejaculate, and erectile dysfunction.
A patient stops taking their long acting once a day beta blocker (Toprol) used for blood pressure reduction. The nurse knows that when this drug is abruptly discontinued, the patient may experience tachycardia. When would the symtoms appear?
In 4-5 days (or half-lives) when the drug comes down from plateau
Why is dextromethorphan kept behind the counter in some pharmacies?
In high doses it can cause hallucinaitions and is often abused by teenagers.
Creatinine
In older adults, the proper index of renal function is creatinine clearance, not serum creatinine levels. As a result, creatinine levels may be normal even though renal function is greatly reduced.
When would ACEI be contraindicated?
In patients with a history of AE, renal failure or bilateral renal artery stenosis, SBP <80 mm Hg, Cr >3 mg/dl, K > 5.5 mEq/L, and during pregnancy or risk of prgnancy
Where do impulses normally originate in a healthy heart?
In the SA node , AV node, and His-Purkinje system.
Where are the beta1 receptors located?
In the heart and kidneys
Where are the beta1 receptors located?
In the heart and kidneys.
Where does most drug metabolism (biotransformation) take place?
In the liver.
Where is iron absorbed?
In the small intestine
What component of speech should be documented in a patient that presents with an asthma exacerbation?
Inability to speak in full sentences is a signal of a severe asthma exacerbation
What is the principal cause of the underlying emergence of resistant TB?
Inadequate drug therapy
A patient on coumadin is prescribed fluoxetine for depression. Both of these drugs bind to protein. Displacement of the warfarin can cause the INR to:
Increase
Agonist-antagonist opioids or partial agonists should nottt be give to patients with MI because they (increase or decrease) cardiac work?
Increase
Alpha1 agonists are used to (increase or decrease blood pressure)
Increase
Bupropion can (increase of decrease) sexual desire?
Increase
Cholinesterase inhibitors, used to treat myasthenia gravis and Alzheimer's disease (increase or decrease) levels of acetylcholine?
Increase
Contraceptive diaphragms and sexual intercourse (increase or decrease) the occurrence of urinary tract infections?
Increase
Does HTN increase or decrease afterload?
Increase
NSAIDs suppress prostaglandins synthesis in the kidney and increase reanal reasorption of lithium. This causes lithium levels to (increase or decrease)?
Increase
Phenytoin has unusual pharmacokinetics called saturable kinetics or "first order kinetics." When the liver is saturated with phenytoin, it becomes overwhelmed and levels of phenytoin in the blood (increase or decrease)?
Increase
Using a BP cuff that is too small will falsely (decrease or increase) the blood pressure
Increase
When the potassium levels are low and the patient is on digoxin there is concern that the digoxin levels will:
Increase
When venous return increases, does cardiac output increase or decrease?
Increase
Serum albumin may be lower in older individuals. This would cause some drug levels to (increase or decrease)?
Increase (more drug is active because there are less albumin molecules to bind to)
During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require (increase or decrease) in drug dosages?
Increase in drug dosages.
During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require (increased or decreased) drug amount?
Increase in drug dosages.
A patient with AD presents with neuropsychiatric symptoms of agitation, aggression, and hallucinations. The nurse knows that antipsychotic drugs:
Increase mortality mainly from cardiovascular events and infection
By blocking the enzyme that breaks down ACh, colinesterase inhibitors used to treat Alzheimer's disease (increase or decrease) the availability of ACh at cholinergic synapses?
Increase. Cholinestrase inhibitors are recommended for treatment of AD.
Drugs used to treat Parkinson's disease such as levodopa (increase or decrease) dopamine?
Increase. Drugs used to treat PD are known as dopaminergics.
Drugs that inhibit CYP34A (azole antifungals, erythromycin and clarithromycin) can (increase or decrease) drug levels of antipsychotics?
Increase. When the drug is not metabolize, it remains active in the system.
A patient with a mechanical heart valve has an INR of 1.9. The nurse knows that the warfarin dose will be:
Increased
Activation of beta1 receptors causes (increased or decreased) heart rate?
Increased
Drugs that are highly bound to protein may exhibit (increased or decreased) levels in the blood when the patient is found to be in a malnourished state.
Increased
Use of warfarin (Coumadin) and azole antifungals can lead to (increased or decreased) INR?
Increased INR can lead to bleeding
Warfarin is a protein loving drug. When other drugs are given that compete for the protein binding sites, warfarin can be displaced. This may result in potential (bleeding or thrombosis)?
Increased active or free drug would lead to bleeding.
Some drugs are inactive and when metabolized undergo conversion to an active form. Other drugs are converted into more active forms. For example, codeine is metabolized into morphine. Some children have the ability to rapidly metabolize codeine (ultra-rapid metabolism of codeine to morphine). The out-come of this will lead to toxicity due to (increased or decreased) opioid effect?
Increased effect leading to respiratory arrest. Do not prescribe codeine to children. See the Boxed Warnings in ePocrates.
Atropine overdose may cause which of the following?
Increased heart rate
patient that is on atorvastatin is given an antibiotic such as clarithromycin that is a potent CYP inhibitor. What could be the end result of this combination?
Increased levels of statin leading to muscle injury, kidney failure, litigation and loss of prescriber's license!
ACEIs used along with lithium can lead to (increased or decreased) lithium levels?
Increased lithium levels
BBs block the effects of SNS activation. What are the undesirable effects of the SNS activation with HF?
Increased myocardial oxygen demand, arrhythmias, ventricular remodeling, myocyte apoptosis, increased preload and afterload
What is the problem encountered with the use of St. John's Wort and SSRI's?
Increased potential for serotonin syndrome. They are both similar in action
Antipsychotis are oten used to treat elderly patients with dementia-related psychosis. This is done "off label" and the FDA warns of_______________?
Increased risk of death due to heart-related events and infection
Antipsychotics such as aripiprazole are sometimes added to the regime for depression in elderly patients. What are the potential problems with this drug in the elderly requiring that providers "start low and go slow?"
Increased risk of mortality from cardiovascular events and infection. In addition, there is increased risk of extrapyramidal symptoms (EPS) such as stiffness, tremor, restlessness, sedation, and hypotension
A patient from Flordia drinks fresh grapefruit juice daily. If the patient is taking carbamazepine, the levels may be (increased or decreased)?
Increased. The grapefruit juice inhibits the metabolism of the carbamazepine allowing more drug to be active in the body because it is not broken down (metabolized)
"Gain of function" mutation of PCSK9 increases the activity of the protein which ultimately leads to less LDL receptors because of the joint degradation of the LDL receptor/PCSK9 complex. With less LDL receptors on the hepatocytes, LDL-C (increases or decreases)?
Increases
A drug that promotes transmitter release (increases or decreases) receptor activation?
Increases
Activation of dopamine receptors in the kidney (increases or decreases) renal blood flow?
Increases
Alcohol increases or decreases the risk of hepatotoxicity with INH?
Increases
Atropine (increases or decreases) heart rate?
Increases
Preventing degradation of ACh ( increases or decreases) muscle strength?
Increases
When a drug mimics the effects of a natural transmitter it (increases or decreases) receptor activation?
Increases
What effect does aldosterone have on plasma volume and blood pressure?
Increases blood volume and blood pressure
Why do SSRI's have a Black Box Warning?
Increases in suicidal ideations can occur with initiation of treatment that occurs more frequently with children, teenagers and young adults. All antidepressants have this warning.
If two drugs are given that both utilize the same p450 hepatic microsomal system, the drug level in the blood of the drug that is not metabolized (increases or decreases)?
Increases.
Why are cholinesterase inhibitors used with caution in patients with asthma?
Increasing ACh can lead to bronchoconstriction.
Which of the 4 high risk groups have the recommendation of treatment with high intensity statins according to the ACC/AHA Guidelines?
Individuals with ASCVD; individuals with LDL-C greater than or equal to 190 mg/dL
What are the 4 high risk groups identified in the ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce ASCVD in Adults that should be treated with statins?
Individuals with clinical ASCVD including: ACS, MI, angina, revascularization, stroke, TIA, and PVD; LDL greater than or equal to 190 mg/dL; DM age 40-75 with LDL > 70 mg/dL; individuals age 40-75 with risk of CV disease >7.5% using the Pooled Cohor
How long is the treatment of active TB?
Induction phase is 2 months. The continuation phase is 4 months
AEDs such as phenobarbital, phenytoin, rifampin and tobacco induce hepatic drug metabolizing enzymes which causes theophylline levels to (increase or decrease)? How should theophylline doses be adjusted?
Induction would decrease theophylline levels and require larger doses.
In determining if a PPD is positive, the area measured is the area of (induration or erythema)?
Induration
Why do infants require smaller doses of opioids?
Infants have a poorly developed blood brain barrier
What is the cause of anemia of chronic disease?
Inflammation decreases the lifespan of the RBCS
What are some limitations in the testing process used to bring drugs to market?
Information on women and children is limited.
The leading cause of poisoning fatalities in young children is ______________?
Ingestion of elemental iron (2-10 grams)
Long acting beta 2 agonists should only be used in conjunction with what other type of asthma medication for the control of persistent asthma?
Inhaled corticosteroids (ICS)
Patients that require daily use of bronchodilators or more than twice a week use, need to have better control of their asthma by using_____________?
Inhaled glucocorticoids
Oropharyngeal candidiasis and dysphonia (hoarseness, speaking difficulty) as well as local deposition of inhaled glucocorticoids are the most common adverse effects of____________?
Inhaled glucocorticoids (ICS)
Grapefruit juice can (inhibit or induce) the metabolism of certain drugs, thereby (raising or lowering) their blood levels?
Inhibit the metabolism of certain drugs raising their blood levels.
When "azole" are used with other drugs, serious interactions can occur. What is the pharmacokinetic explanation for the interactions?
Inhibition of CYP 3A4 metabolizing enzymes increases levels of many other drugs
What is the mechanism of action (MOA) of ezetimibe?
Inhibition of cholesterol in the small intestine
What is the MOA of selective serotonin reuptake inhibitors (SSRIs)?
Inhibition of serotonin reuptake. More serotonin is available at the synapses.
Cimetidine and fluoroquinolone antibiotics inhibit hepatic metabolism causing theophylline levels to (increase or decrease)? How should theophylline doses be adjusted?
Inhibition will lead to increased levels. The dose will need to be decreased.
Dopamine is an (inhibitory or excitatory) neurotransmitter?
Inhibitory. Dopamine inhibits GABA.
How long does it take to reach a therapeautic response when using antipsychotic drugs?
Initial 1-2 days, substantial improvement 2-4 weeks, full effect a few months.
When would you expect to see a therapeutic response to treatment using a TCA?
Initial response occurs in 1-3 weeks, maximal response occurs in 1-2 months.
A patient on an SSRI may experience which of the following?
Insomnia Increase in suicidal thoughts upon initiation Increased bruising Bruxism Headache
Mirtazapine (Remeron) is an atypical antidepressant is often used for_________?
Insomnia because it is sedating.
Which of the following drug(s) have been identified as having the most adverse effects? (Choose all that apply) Notice that the selection boxes come up as squares when there are multiple answers. Partial credit is given and a deduction in given for answers that are chosen that are incorrect.
Insulin Heparin Digoxin Glipizide
In order for niacin to be effective, it must be titrated to about 3-4 grams a day. The reaction that can send a patient to the ED from niacin is:
Intense flushing
What is the measurement used to monitor coagulation that is determined by multiplying the observed PT ratio by a correction factor specific to the particular thromboplastin preparation employed for the test?
International Normalized Ratio (INR).
What is sprue?
Intestinal malabsorption that decreases folic acid uptake
How is status epilepticus treated?
Intravenous BZDs and fosphenytoin (Cerebyx)
What is tardive dyskinesia?
Involuntary twisting, writhing, worm-like movements of the tongue.
What kinds of compounds do not pass freely from the maternal bloodstream into the blood of the fetus?
Ionized, highly polar, protein bound drugs remain in the bloodstream.
Short-acting muscarinic-antagonist SAMA
Ipatropium
Give and example of a drug used to treat respiratory problems.
Ipatropium blocks the muscarinic receptors in the lung which leads to bronchodilation
Select the drugs that are classified as anticholinergics: (choose all that apply)
Ipatropium bromide (Atrovent) Tolterodine (Detrol) Drugs used to treat overactive bladder
A patient presents to the ED with an asthma exacerbation. Which of the following are bronchodilators that may be used?
Ipratropium Albuterol
The expansion of maternal blood and the production of fetal RBC's are two reason that________ requirements increase during pregnancy.
Iron
A hemogram that demonstrates a low MCV and MCHC (small and pale) is most likely________?
Iron deficiency anemia (microcytic)
Severe allergic reactions can occur with ________________?
Iron dextran which is given parenterally
How does clonidine (Catapres) decrease blood pressure?
It activates the alpha 2 receptors in the CNS to decrease SNS outflow. When norepinephrine is decreased, blood pressure falls.
Why is clonidine approved for pain relief?
It blocks nerves that transmit pain signals
Why do you need to monitor thyroid function tests (TFTs) every 3 months when patients are on amiodarone?
It can cause hyper-or hypothyroidism
What is the cost to develop a new drug in the U.S.?
It can exceed $800 million dollars.
Why do you need to watch for a gradual decline in platelets and discontinue heparin immediately if the trend is noticed?
It could be a sign of heparin induced thrombocytopenia (HIT).
Why is the API important?
It distinguishes chronic disease and can lead to better care
What is the purpose of carbidopa?
It enhances the effect of levodopa
Describe how sucralfate (Carafate) promotes ulcer healing.
It forms a very sticky gel that adheres to the ulcer crater, creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts.
What effect does orlistat have on the liver?
It has been associated with liver failure
Tramadol (Ultram) is a strong analgesic. Which of the following statements are true:
It has serontonergic properties It can increase the risk of seizures It blocks uptake of NE and serotonin It is a weak agonist at mu receptors
What is the significance of a positive Comb's test?
It indicates that there are auto-antibodies that can attack the RBCs causing hemolytic anemia. It is a rare event. Methyldopa, PCN, cephalosporins and beta-lactamase inhibitors can cause hemolytic anemia.
St. John's wort is used to treat mild to moderate depression. It has a long list of drug interactions. Which of the following statements are true?
It induces the metabolism of other drugs decreasing their effects Patients taking protease inhibitors may have decreased CD4 counts It has serotonergic properties
What is a cascade screening?
It is a process for identifying family members who are at risk for familial hypercholesterolemia (FH).
Why is excess iron a problem?
It is an oxygen radical and excess levels are associated with increase morbidity and mortality
Why should sublingual nifedipine be avoided?
It is associated with increased morbidity and mortality likely related to the excessive fall in BP
Can nitrofurantoin be given to patients with diminished renal function?
It is contraindicated in patients with altered renal function
Does GERD exacerbate asthma?
It is possible and often PPIs are given as a trial to see if asthma symptoms diminish
Creatine kinase (CK) is a marker for muscle injury. Should it be assessed prior to treatment with a statin?
It is recommended to check the levels in patients with risk factors for myopathy or whenever it is clinically indicated.
How long does lipid lowering therapy last?
It is usually lifelong. Cholesterol levels will return to pretreatment levels when lipid lowering agents are discontinued
Is vitamin D helpful in patients with statin induced myalgias?
It may be helpful to supplement with vitamin D in patients with low levels to reduce myalgias.
Why is filgrastim (Neupogen) not used in patients with cancers that originate in the bone marrow (myeloid tissue)?
It stimulates proliferation of bone marrow cells & cancer cell growth
How many half-lives does it take for a drug to reach plateau?
It takes approximately four half-lives to reach plateau.
JNC-7 first line agent for BP lowering if no compelling indications was thiazide diuretics. JNC-8 and ACC/AHA 2017 recommends _________?
JNC-8 gives four choices, thiazide diuretics, ACEIs, ARBs, or CCBs
What is the condition due to a buildup of bilirubin in newborn brains that can occur when sulfonamides displace bilirubin?
Kernicterus
What is the problem with telithromycin (Ketek)?
Ketek has been associated with liver failure
What kind of diet has been shown to decrease seizures.
Ketogenic diet
Where are Dopamine receptors located?
Kidney
A 30 year old presents with stage 2 hypertension and is not controlled with 3 classes of antihypertensive agents. Which of the following may be secondary causes of hypertension?
Kidney disease Pheochromocytoma Sleep apnea Thyroid disease Cushing's syndrome
What are the differences between LDL and HDL lipids?
LDL lipids promote athlerogenesis. HDL lipids are cardioprotective.
How is familial hypercholesterolemia (FH) diagnosed?
LDL-C greater than or equal to 190 mg/dL or 160 mg/dL in children is usually an indication of a genetic dysfunction in the LDL receptors. The genetic tests for FH that are available are not generally recommended.
A patient presents with an elevated TSH and a low free T4 (FT4) indicating hypothyroidism. Why is it important to reach euthyroid (normal TSH and FT4) before treating the hyperlipidemia?
LDL-C may be elevated when the thyroid gland is underperforming. Correction of the thyroid abnormality will usually normalize LDL-C levels.
Which non selective beta blockers also selectively blocks alpha1 receptors?
Labetalol (Trandate, Normodyne) and carvedilol (Coreg)
Name the beta blocker that has both beta blocking and alpha blocking abilities.
Labetolol
What are the preferred drugs for treatment of eclampsia?
Labetolol and magnesium sulfate to reduce the risk of seizures
Beta adrenergic antagonists: 3rd generation vasodilating alpha and beta blockers
Labetolol: Blocks alpha receptors in the veins causing vasodilation and beta receptors in the heart and lungs.
The most commonly recognized factors contributing to the low control rate of HTN
Lack of access to health care, large percentage of uncontrolled HTN found in ethnic and racial minorities, and poor patient compliance
Morphine has a large "first-pass" metabolism. Oral doses are (larger or smaller) that parenteral doses?
Larger
Laxatives (reduce or increase) absorption?
Laxatives speed passage of drugs through intestine, reducing absorption.
An expectant mother exposes her fetus to an illicit drug during the fetal period (2nd or 3rd trimester). The exposure is most likely to produce:
Learning deficits and behavioral abnormalities
Agonist-antagonist opioids or partial agonists have (more or less) risk of respiratory depression, pain relief, and potential for abuse?
Less
Parkinson's disease is a disorder of the extrapyramidal system, a complex neuronal network that helps to regulate movement. The neurons that supply dopamine in the substantia nigra produce (more or less) dopamine. This change in the dopamine along with increased levels of ACh leads to abnormal movements.
Less
Why are cardioselective beta blockers preferred?
Less bronchoconstriction occurs when only beta 1 receptors are blocked.
Drugs that have a long half-life need to be administered (more or less) frequently than drugs that have a short half-life.
Less frequently.
Do ARBs lead to hyperkalemia, or cough ?
Less hyperkalemia or build-up of bradykinin that leads to cough
Singular (montelukast) which helps treat asthma symptoms is indicted for maintenance therapy. What is the name of the inflammatory agent blocked by this drug?
Leukotrienes
Which drug used to treat PD can darken sweat and urine, and activate malignant melanoma?
Levadopa darkens sweat and urine and can activate malignant melanoma.
Visual hallucinations, vivid dreams, nightmares, and paronoid ideation are all major side effects of which therapeutic agent used to treat PD?
Levadopa/carbidopa
Which dopaminergic agent is the the most effective in treating the motor symptoms of PD?
Levadopa/carbidopa. Often, other agents are started first to preserve this drug for later more severe manifestation of PD.
Many providers prefer levalbuterol over albuterol. What are the reasons for this preference?
Levalbuterol (Xopenex) has less cardiovascular side effects (tachycardia)
Which dopaminergic agent used to treat PD can have a gradual "wearing off" and "on-off" phenomenon?
Levodopa/carbidopa
Which of the following drugs is the most effective drug for PD?
Levodopa/carbodopa
Which of the following drugs has the longest half life (T 1/2 )?
Levofloxacin 750 mg daily
Which of the following has a remote risk of harming the fetus if given to a pregnant woman (Formerly called FDA Category A-this classification is no longer used)?
Levothyroxine
Does Lidocaine have a significant effect on the EKG?
Lidocaine has no significant effect on the ECG.
What are other measures recommended in patient with angina to prevent MI?
Lipid lowering agents, antiplatelet drugs, ACEIs, control of BP and blood sugar, physical activity and smoking cessation
What types of compounds pass freely from the maternal blood stream into the blood of the fetus?
Lipid soluble compounds and non-ionized compounds.
Drugs need to exit the vascular system to reach their target and be metabolized and excreted. Choose the correct statements regarding drug movement. (Choose all that apply)
Lipid soluble drugs are able to cross the blood brain barrier Warfarin (an anticoagulant) is a drug that is highly bound to protein (99%). Drugs compete for protein binding sites. If one drug displaces another from albumin, the free concentration of the displaced drug will rise.
Which of the following are true about placental drug transfer: (Choose all that apply)
Lipid soluble drugs cross the placenta easily Drugs with large molecular weights such as heparin and insulin do not pass into the fetal circulation Factors that determine drug passage across membranes of the placenta are the same factors that determine drug passage across other membranes
Select the true statement regarding absorption of drugs.
Liquid preparations are absorbed more rapidly than tablets
Which of the following drugs have indications for the treatment of heart failure:
Lisinopril Spironolactone Digoxin Furosemide Carvediolol
SSRIs and other mood altering drugs are sometimes used in pregnancy if the benefit outweighs the risk of fetal harm. Which of the following are a Pregnancy Risk Category D and should not be used during pregnancy?
Lithium Paroxetine (Paxil)
Why do patients taking lithium need to maintain hydration?
Lithium promotes polyuria by antagonizing the effects of ADH.
GI upset, diarrhea, muscle weakness, thirst, incoordination, severe hypotension, convulsions, and death are all adverse effects of ____________.
Lithium when taken in excessive amounts.
Ramelteon (Rozerem) is a melatonin agonist and has the potential for causing________injury?
Liver
Why is alcohol consumption a concern in patients treated with statins?
Liver damage my be present in patients with excessive use of alcohol. The combination of both statins and excessive alcohol may further damage the liver.
What lab test should be closely monitored in patients taking valporic acid (Depakote)?
Liver transaminases (ALT and AST)
What laboratory value should be monitored in patients receiving statins?
Liver transaminases (ALT and AST) were previously monitored. Newer recommendations from the FDA do not recommend checking for liver injury because it is rare. A check prior to initiation of therapy, 6-8 weeks following initiation or when clinically indicated such as signs of liver dysfunction is now recommended.
A patient with bipolar disorder is taking valproic acid. Which lab test needs to be monitored?
Liver transaminases (ALT, AST)
Topically
Local therapy of the skin, eyes, ears, nose, mouth, rectum, and vagina.
Nociceptive pain is somatic and viceral. Somatic pain results from injury to tissue (bones, joints, and muscles) and the pain is generally described as___________________?
Localized and sharp
Drugs with a (long or short) half-life should be avoided when breastfeeding.
Long
Serevent Diskus (salmeterol) and Foradil (formoterol) are example of what type of beta-2 agonists?
Long acting beta-2 agonists (LABAs)
Which class of diuretics is especially useful in patients with renal impairment?
Loop diuretics
Which of the following drugs are indicated for the treatment of allergic rhinitis:
Loratadine (Clarinex) Intranasal cromolyn Pseudoephedrine Fluticasone (Flonase)
Which ARB is considered uricosuric (able to lower serum uric acid levels)?
Losartan may be helpful in patients with HTN and gout
Which statin needs to be given with the evening meal?
Lovastatin
Which statins should be avoided in patients concurrently being treated with protease inhibitors?
Lovastatin (Mevacor) and simvastatin (Zocor)
Low-molecular-weight (LMW) heparin also known as
Lovenox (LMWH)
Which lipoproteins carry the most cholesterol and are more atherogenic?
Low density lipoproteins carry more cholesterol and are less dense than high density lipoproteins that carry protein
Describe the "negative" symptoms of schizophrenia.
Low motivation, lack of speech, blunted affect, & social withdrawal.
What is the potential problem when diuretics and digoxin are used together?
Low potassium can increase digoxin levels to toxic range
What is the potential problem when lithium and diuretics are combined?
Low sodium can elevate lithium levels to toxic levels
Older adults have more body fat and decreased total body water. Because of this plasma concentrations of lipid-soluble drugs may be (low or high) and concentrations of water-soluble drugs may be (low or high).
Low, high
Hepatic metabolism and renal excretion in infants is (high or low)?
Low.
How rapid should BP be lowered in HTN urgency or emergency
Lower BP in 24-48 hours with combination therapy in patients with urgency. In hospitalized patients, lower the mean arterial BP 25% in the first hour and then lower to 160/100 within 6 hours
Why is it important to use lower doses of thiazide diuretics in older adults?
Lower doses such as 12.5 mg-25 mg seem to be as effective as higher doses with out as many adverse effeccts
Phenelzine
MAOI
Which drug classes can intensify the effects of alpha agonists such as epinephrine, dopamine, and dobutamine and require a reduction in dosage when used concurrently?
MAOIs and TCAs, and general anesthetics
How can you tell the difference between angina pain and MI pain?
MI pain lasts longer than 20 minutes and is not totally relieved by NTG.
Which fish contain the important EPA and DHA ingredients that are thought to be beneficial?
Mackerel, halibut, herring, salmon, albacore, tuna, and trout
How is B12 deficiency diagnosed?
Macrocytosis (increased MVC) and decreased B12 levels
Which class of antibiotics is considered first line treatment of community acquired pneumonia due to the activity against the "atypical" organisms?
Macrolide antibiotics such as erythromycin, azithromycin, & clarithromycin. Some clinical practice guideline groups are changing their recommendation concerning the use of macrolides. If atypical bacteria is suspected, macrolides are still recommende
What class of antibiotics is considered first line for treatment of CAP?
Macrolides and if risk for DRSP, respiratory FQ
What type of antacids cause diarrhea?
Magnesium hydroxide.
What is a normal CK level?
Male 52-200 ng/mL Female 35-165 ng/mL
One million individuals in the U.S. have Parkinson's disease (PD). It is more common with a ratio of 3:2 in (males or females)?
Males
An adverse reaction triggered by succinylcholine as well as all inhaled anesthetics in which temperature elevates due to uncontrolled metabolic activity in muscle is called______________________?
Malignant hyperthermia
Muscle rigidity and profound elevation in temperature are promient symptoms of ___________________?
Malignant hyperthermia
__________ is a rare life threatening syndrome that can be triggered by any general anesthetic agent and by succinylcholine (a neuromuscular blocking agent).
Malignant hyperthermia
Patients with BPD can have worsening of _____ when SSRIs are initiated. It is important to rule out BPD before starting SSRIs. These patients need mood stabilizers.
Mania
Should patients with diabetes ever receive beta blockers?
Many endocrinologists favor beta blockade in patients with diabetes to decrease the adverse effects of catecholamine release.
How long does it take to achieve an effect with the use of an ICS?
Maximal benefits may not be evident for 4-6 weeks, improvement in 2-6 days (in a patient taking nebulized budesonide (Pulmicort Respules))
Efficacy
Maximal efficacy is defined as the largest effect that a drug can produce. Maximal efficacy is indicated by the height of the dose response curve.
What is the potential problem of using diuretics along with ACE inhibitors?
May intensify first dose hypotension. If a patient is on a diuretic and an ACEI or ARB is added, it is sometimes a good idea to suspend the diuretic to avoid excessive blood pressure lowering (it depends on the level of the BP)
What are peak flow measurements?
Measures that can be done at home to assess asthma control
Why do African Americans with HTN have higher morbidity and mortality?
Medical providers are not aggressive with treatmen and African Americans consume less potassium
Lipophillic
Membranes are composed primarily of lipids; therefore, to directly penetrate membranes, a drug must be lipid soluble (lipophilic).
Both of the MAO-B inhibitors selegiline and rasagiline can cause HTN crisis and have major drug interactions with_____?
Meperidine, tramadol MAOI inhibitors, SSRIs, dextromethorphan (all have serotonergic properties and can lead to serotonin syndrome)
Older antipsychotic agents cause more EPS, however the newer atypical or second-generation antipsychotic cause more_____________
Metabolic derrangements (weight gain, diabetes, and hyperlipidemia)
Small hand-held, pressurized devices that deliver a measured dose of drug with each activation are called____________?
Metered dose inhalers (MDIs)
Which opioid can prolong the QT interval and lead to fatal dysrhythmias?
Methadone
Which alpha 2 agonist can cause hepatotoxicity?
Methyldopa
Which alpha2 agonist is the preferred agent for management of hypertension during pregnancy?
Methyldopa
Which of the following drugs are used in pregnant women to control hypertension?
Methyldopa Hydralazine Magnesium sulfate
What anti-adrenergic agent can cause a positive Coomb's test and hemolytic anemia?
Methyldopa (alpha-2 agonist)
HTN is the most common complication in pregnancy. Which agents are used for chronic HTN?
Methyldopa and labetolol
Ritalin (methylphenidate) used to treat ADHD can cause (weight loss or weight gain)?
Methylphenidate can cause weight loss.
Nancy has a history of severe allergies to shellfish and is always certain to have her EpiPen with her. She was recently diagnosed with hypertension. Which medication choice would not be selected because it would block the beta receptors and render the epinephrine ineffective in the event of an accidental exposure to shellfish?
Metoprolol
Which beta blocker would be appropriate for a patient with asthma?
Metoprolol is a good choice because it is a cardio-selective BB. In higher dosages it can still cause problems in patients with asthma
Generic forms of metoprolol are metoprolol succinate and metoprolol tartrate. Which of these is given BID?
Metoprolol succinate is long acting. Metoprolol tartrate is on the $4 drug list and must be given every 12 hours.
Beta adrenergic antagonists- 2nd generation cardioselective prototype and MOA
Metoprolol: Blocks Beta 1 receptors.
What is the treatment for trichomoniasis?
Metronidazole (Flagyl) 2gm po x1 or 500mg po bid x 7 days
How is BV treated?
Metronidazole (Flagyl) 500mg po bid x 7 days or Metro vaginal gel x 5 days
What type of headache is characterized by a neurovascular disorder that involves vasodilation and inflammation of the intrcranial blood vessels?
Migraine headache
AEDs are also used for:
Migraine prophylaxis Pain syndromes Peripheral neuropathy Postherpetic neuralgia (PHN) Fibromyalgia Bipolar disorder (BPD)
What are some examples of substances that contain metal ions that may form non-absorbable chelates when administered with tetracycline?
Milk products, calcium & iron supplements, magnesium laxatives, & antacids
A patient presents with multiple skin lesions resembling "spider bites." Antibiotics effective against CA-MRSA include:
Minocycline Trimethoprim /sulfamethoxazole Clindamycin
Which of the following is a common effect of muscarinic stimulant drugs?
Miosis
Opioids cause (miosis or mydriasis) and can lead to falls in older individuals.
Miosis (constriction)
What is the effect of activation of muscarinic receptors in the eyes?
Miosis (constriction) Recall Mr. Pathetic
Even though SSRIs can be energizing and lead to difficulty initiating sleep, they can also restore sleep by treating depression. If insomnia occurs an atypical agent that is sedating such as__________can be added?
Mirtazapine (Remeron)
Treating untreatable infections such as a virus (common cold, varicella, or mumps) , treatment of fever of unknown etiology, improper dosing,, treatment in the absence of adequate bacterial information, and omission of surgical drainage (such as treating an abscess without doing the I&D) are all examples of_______________?
Misuse/overuse & abuse of antibiotics
Why are antidepressants helpful for chronic pain?
Modulation of serotonin and NE decrease pain
Agonist
Molecules that activate receptors.
How often do you need to monitor potassium and kidney function while on aldosterone antagonists?
Monitor at 3 days, one week, monthly for 3 months then every 3 months
Why are asthmatics asked to monitor their peak expiratory flow rates?
Monitor their status.
What types of drugs are used to treat BPD?
Mood stabilizers, antipsychotics, and antidepressants
Antipsychotics can reduce the seizure "threshold" leading to (more or less) frequent seizures?
More
When triglycerides are elevated, LDLs, become smaller and (more or less) atherogenic?
More
A drug with a narrow therapeutic range is (more or less) dangerous?
More dangerous.
A percentage of codeine (10%) is converted in the liver to morphine. Some individuals are unable to convert codeine to morphine and the codeine is less effective. On the contrary, some individuals are "ultra-rapid metabolizers." This process would cause the codeine to be (more or less effective?)
More effective. This has led to a Black Box Warning that children using codeine can have severe respiratory depression and death if they are "ultra-rapid metabolizers" of codeine.
(More or less) of the other medication would be needed?
More would be needed.
Angioedema is (more or less) prevalent in Blacks?
More-caution when using an ARNI if the individual is Black
What are two drugs known to decrease peristalsis and cause increased drug time (and increased absorption) in the intestines?
Morphine and atropine.
Why is meperidine (Demerol) used in patients who have had biliary surgery rather than morphine for relief of pain?
Morphine can induce spasm of the common bile duct and intensify pain.
Which drug used to treat an MI reduces pain and anxiety, reduces preload by venous dilation, reduces afterload by arterial dilation and lowers myocardial O2 demands ?
Morphine sulfate.
Do statin dosages need to be reduced in patients with renal impairment?
Most statins require lower doses in patients with renal disease. Atorvastatin and fluvastatin are preferred in patients with kidney disease.
How do aldosterone blockers improve HF?
Mostly due to the neurohormonal inhibition of aldosterone-mediated cardiac fibrosis and ventricular remodeling
Select the therapeutic indications for the use of antimuscarinic drugs. (choose all that apply)
Motion sickness Chronic obstructive pulmonary disease (COPD) Overactive bladder
Side effects of drugs used for AD mimic the parasympathetic response which is (Mr. Pathetic or BUDCATS)?
Mr. Pathetic. This is a cholinergic response.
Analgesia, respiratory depression, euphoria, and sedation are all effects from the activation of what type of receptors?
Mu receptors
Activation of ___________________receptors have the following effects: Miosis Decreased Heart rate Constriction of bronchi Promotion of Lung secretions Bladder Voiding Salivation, gastric secretions, intestinal tone, & motility Defecation Generalized sweating Erection Vasodilation
Muscarinic
What are some of the uses for cholinesterase inhibitors?
Myasthenia gravis, Alzheimer's, glaucoma, & reversal of neuromuscular blocking
A patient with myasthenia has severe muscle weakness and trouble breathing. She is given edrophonium and her symptoms approve. The patient has:
Myasthenic crisis
Activation of alpha1 receptors located in the eye causes (miosis or mydriasis)
Mydriasis (wide-eyed with fear)
State the three factors that determine stroke volume
Myocardial contractility, preload and afterload
State the three factors that determine stroke volume.
Myocardial contractility, preload and afterload
Chest pain, shortness of breath, pain radiating to jaw or arms, diaphoresis, nausea, indigestion can be clinical signs of_____________?
Myocardial infarction.
What is the difference between myopathy and myositis?
Myopathy is muscle pain. Myositis is actual muscle injury and is diagnosed by evidence of elevated creatine kinase (CK) levels.
Have nitrates been shown to decrease mortality in patients with CHD?
NO, they are not effective in decreasing mortality like CCBs and BB's
Which of the following is true about NPs in Florida:
NPs in Florida can write a prescription for alprazolam Psych NPs in Florida can write prescriptions for Adderall NPs in Florida have physician oversite
Which drug category can decrease the antihypertensive effects of ACEIs?
NSAIDs
Describe how NSAIDs worsen HF
NSAIDs cause sodium retention and peripheral vasoconstriction and reduce the efficacy of diuretics and ACEIs
Name some drugs that can exacerbate asthma
NSAIDs if sensitivity exists and beta blockers
Which drug class should not be used routinely because of the increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture?
NSAIDs other than aspirin should be discontinued
What general groups of drugs are used for cancer pain?
NSAIDs, acetaminophen, opioids, TCAs, AEDs
Venlafaxine
NSRI
What is the difference between NSRIs and SSRIs?
NSRIs block the reuptake of serotonin and norepinephrine
What other lifestyle interventions can lower BP by 2-9 mm Hg?
Na restriction 2.4 g sodium; limit ETOH, 30 minutes aerobic exercise/day
A patient present with coma, respiratory depression, and pinpoint pupils. What drug should be administered?
Naloxone (Narcan)
The lethal dose of TCAs is only 8 times the average daily dose. The therapeutic range for TCAs is (narrow or wide) indicating a negative safety profile?
Narrow
Phenylephrine given topically is an alpha1 agonist that treats _____________?
Nasal congestions
substances that can sabotage hypertensive therapy
Nasal decongestants, NSAIDs, caffeine, appetite suppressants, oral contraceptives, adrenal steroids, sympathomimetics, nicotine, cocaine, alcohol. Others include cyclosporine, tacrolimus, erythropoietin, and licorice
What are the major side effects with levodopa?
Nausea and vomiting, dyskinesias, hypotension, dysrhythmias, & psychosis.
Nausea is a common SE of morphine. What measures may help alleviate the nausea?
Nausea is often a temporary effect and can be lessened by keeping still.
Which newer beta blockers blocks beta1 receptors and dilates arteries by promoting the synthesis and release of nitric acid? Which newer beta blocker is cardio-selective and has vasodilating properties?
Nebivolol (Bystolic)
A patient with no risk factors and an induration of 10 mm after PPD is considered (negative or positive)?
Negative
Which medications used to lower lipids have not been shown to decrease morbidity and mortality?
Neither niacin nor fibric acid derivatives have been shown to improve outcomes. Ezetimibe has recent good outcome evidence when used with a statin
Which drug treats myasthenia gravis by increasing muscle strength?
Neostigmine (Prostigmin)
What are the adverse effects of aminoglycosides?
Nephrotoxicity and ototoxicity
400 mg of folic acid daily is recommended to prevent_____________?
Neural tube deficits (spinal bifida and anencephaly)
_____________ is a serious disorder with "lead pipe" rigidity, high fever, sweating, autonomic instability, dysrhythmias, and BP fluctuations
Neuroleptic malignant syndrome (NMS)
Where are Nicotinicm receptors located?
Neuromuscular junction
Pain that is described as burning, shooting, jabbing, or numbness is called_____________?
Neuropathic pain
What is another limitation in the testing process used to bring drugs to market?
New drugs are likely to have adverse effects not detected in clinical trials.
For patients with chronic asymptomatic HIV, HAART is recommended when the CD4 count drops below:
New guidelines recommend starting HAART when HIV positive regardless of CD4 count
Lamotrigine
Newer AED
Which of the following agents have less extrapyraminal side effects: atypical antipsychotics or conventional agents?
Newer atypical antipsychotics (second generation antipsychotics) have fewer EPS.
A patient arrives to the emergency department with complaints of a severe "flushing" sensation. The patient was recently started on a lipid lowering agent. The drug most likely to cause this side effect is:
Niacin
Which cholesterol lowering agent can exacerbate a gouty attack?
Niacin
What effect does nicotinic acid (niacin) have on blood sugar levels?
Nicotinic acid can elevate blood glucose and uric acid.
Activation of ___________________receptors have the following effects: Contraction of skeletal muscle
Nicotinicm
Activation of ___________________receptors have the following effects: Stimulation of parasympathetic and sympathetic postganglionic nerves and release of epinephrine from the adrenal medulla
Nicotinicn
Dihydropyridine Calcium Channel Blockers
Nifedipine Nisoldipine Amlodipine Adalat Cardene Norvasc Can lead to peripheral edema Used for hypertension Are useful for treatment of angina
Patients with asthma often have a cough that worsens during the (day and night)?
Night
Which drug used to treat urinary tract infections can cause a harmless brown color to the urine?
Nitrofurantoin (Macrobid)
A patient with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following medications if used concurrently would cause hypotension?
Nitroglycerin
What drug used in the treatment of STEMI reduces preload, decreases MVO2, increases collateral blood flow in the ischemic region of the heart, controls HTN, limits infarct size and improves LV function?
Nitroglycerin
Antianginal drugs decrease cardiac oxygen demand by decreasing heart rate, contractility, afterload, and preload. Which of the following drugs has indications in the treatment of angina:
Nitroglycerin Isosorbide dinitrate Metoprolol Verapamil Ranolazine
What is an example of a drug that if given orally would be destroyed in the "first pass" through the GI tract?
Nitroglycerin given sublingual.
Give an example of a drug that exhibits tachyphylaxis
Nitroglycerine
Name the two vasodilators that selectively dilate only the veins
Nitroglycerine and isosorbide dinitrate used for angina
Are beta lactam antibiotics effective against MRSA?
No
Are children that have febrile seizures at higher risk for developing epilepsy later in life?
No
Are macrolides effective against DRSP?
No
Can drugs give cells new function?
No
Can montelukast (Singular) be used for rescue?
No
Can patients with a PCN allergy take Augmentin?
No
Can pregnant women or children less than 2 years of age be treated for head lice with permethrin (Elimite)?
No
Can the iron needs of a pregnant woman can be met by diet alone?
No
Do pharmacodynamics change throughout the lifespan?
No
Is ciprofloxacin considered a respiratory FQ?
No
Is reduced iron uptake a common cause of IDA?
No
Is there solid evidence that drugs, nutrients, supplements, exercise, cognitive training, or any other intervention can prevent AD or delay cognitive decline?
No
Should ACEIs and ARBs be use together?
No
Should DRIs be used with ACEIs or ARBs?
No
Should statins be used in patients with alcoholic or viral hepatitis?
No
Can you use and ARNI in pregnancy?
No (ARB component is contradicted in pregnancy)
According to the ACC/AHA Guidelines are non-statin routinely recommended?
No because non statin drugs have failed to show a decrease in cardiovascular risks
Can you use Combivent if you have peanut allergy?
No because the carrier in the inhaler contains soya lecithin which is related to peanuts and can cause anaphylaxis in individuals with peanut allergy
Should carvedilol or labetalol be given to patients with asthma?
No because they are non cardio-selective and block the beta1 receptors in the heart and beta2 receptors in the lung that can lead to bronchoconstriction
According to the ACC/AHA Guidelines, is it necessary to titrate by stating with lower doses of statins?
No because this may lead to under treatment, however it may be necessary in patients that can't tolerate the higher doses of statins
What is the recommended infusion rate for intravenous potassium replacement?
No more than 10 mEq/hour diluted for adults
What is the recommended infusion rate of intravenous potassium replacement?
No more than 10 mEq/hour diluted for adults
What is the goal of non-HDL-C level in high risk patients?
No more than 30 mg/dL above the ideal LDL-C level (NLA)
Are ICSs used as rescue medications?
No, ICSs are not used for rescue because the onset of action is 3-4 days.
Can you mix PCN and aminoglycosides in the same IV solution?
No, PCN inactivates aminoglycosides
Are thiazide diuretics effective in patients with decreased glomerular filtration?
No, They are ineffective with kidney impairment (eGFR 15-20 ml/min). Loop diuretics are needed.
Should SSRI's be abruptly discontinued?
No, abrupt discontinuation can result in a withdrawal syndrome.
Is clonidine a good choice for a woman of child-bearing age?
No, clonidine is embryotoxic in animals and is not recommended for pregnant women
Are SSRI's and MAOI's compatible?
No, due to the risk of serotonin syndrome.
Is activation of alpha2 receptors in the periphery significant?
No, however activation of alpha2 receptors in the CNS leads to antiadrenergic responses such is the case with clonidine (decrease in BP and heart rate)
Can a patient with a severe allergic reaction to PCN take a cephalosporin?
No, however, cephalosporins are prescribed in patients allergic to PCN as long as the allergic reaction was not severe, such as a rash. Patients with IGE mediated anaphylaxis should not receive cephalosporin antibiotics
Does digoxin decrease mortality in patients with HF?
No, however, it decreases morbidity (hospitalization)
Is carvedilol (Coreg)a selective beta blocker?
No, it blocks beta 1 and beta 2 receptors and alpha receptors.
Is labatelol a cardioselective beta blocker?
No, it blocks beta 1 and beta 2 receptors and alpha receptors.
Is cyanocobalmin ever given intravenously?
No, never
Can warfarin be used during pregnancy?
No, the preferred agent is heparin
Can catecholamines be given orally?
No, they are given parenterally. Non-catecholamines can be given orally
Are beta blockers used for variant angina?
No, they are not effective in the treatment of variant angina
Can you combine MAOIs with TCAs and/or SSRIs?
No, they can produce hypertensive crisis.
Should a patient with seizure disorder take tramadol?
No, tramadol can increase seizure risk
Do individuals absorb the same amount of iron?
No-if deplete of iron-absorption in increased
Do men generally need iron supplementation?
No-look for man vitamins without iron
Can ACE inhibitors be used in pregnancy?
No. ARBs are also contraindicated in pregnancy.
Is it possible to have a selective drug?
No. All medications have side effects.
Is it recommended to start low and go slow when prescribing statin?
No. Calculate the percent of reduction needed and prescribe an agent that can get the patient at goal
Is clonidine considered a first line drug for treatment of HTN?
No. Clonidine has too many adverse effects to be considered as a first line agent
Is it advisable for pregnant women to take ergotamine?
No. Ergotamine is Pregnancy Risk Category X (this classification is no longer used). It can cause uterine contractions.
Can ciprofloxacin or any other fluoroquinolones be given to children, pregnant or nursing mothers?
No. Fluoroquinolones can cause tendon rupture and changes in cartilage.
Is wheezing a reliable indicator of asthma severity?
No. It may be absent in between acute attacks and unable to be heard because of diminished air flow
Roflumilast (Daliresp) is used to reduce exacerbations of COPD. Is it considered a bronchodilator?
No. Its MOA is not well understood. It is thought that increasing cylic AMP improves function of lung cells
Is it advisable for pregnant women to take lithium?
No. Lithium is Pregnancy Risk Category D.
Do you need to taper a prednisone burst of 5 days?
No. Longer treatment of 7-10 days may be tapered.
Is it adviseable to use a triptan with an ergot alkaloid or MAOI?
No. MAOIs can suppress degradation of sumatriptan, increasing plasma levels
Is it necessary to use one of the risk calculators in patients with DM?
No. Patients with DM age 40 and above are automatically placed in high risk groups and statins are recommended to decrease morbidity and mortality
Can statins be used during pregnancy?
No. Statins are category X. The risk to the fetus outweighs potential benefit.
Can pregnant women take tetracycline antibiotics such as minocycline or doxycycline?
No. Tetracyclines are Pregnancy Risk Category D (proven risk of fetal harm)
Can patients with heart disease or cardiovascular risk factors take triptans?
No. The most severe AE of triptans is vasospasm. This is different from the transient chest tightness. Use triptans in individuals that are free of ASCVD and or have not risk factors.
Is it necessary to use a risk calculator in a patient with clinical signs of ASCVD, CM, or evidence of HF?
No. These patients are at obvious high risk for ASCVD. The risk calculators identify patients that may not have obvious risks.
Are ACEIs and ARBs recommended for primary prevention of diabetic nephropathy?
No. They should be initiated in the presence of HTN or in a normotensive patient with diabetes and evidence of microalbuminuria. They should not be prescribed to normotensive patients with DM unless there are signs of renal impairment (microalbuminuria).
Are beta blockers considered "first line" agents for patients with HTN?
No. They used to be considered first line agents for HTN. Other agents such as ACEI, ARBs, diuretics and CCBs are better at reducing BP and have less adverse effects. Beta blockers are essential in patients with ASCVD and are sometimes used for HTN to treat comorbid conditions such as migraines, heart failure, dysrhythmias and the like.
Is there any evidence that fibrates reduce morbidity and mortality due to ASCVD?
No. This is the reason that statins should be primarily used for dyslipidemia
Gabapentin is often used for diabetic peripheral neuropathy (DPN). Is it formally FDA approved for this use?
No...because of its low price and efficacy it is used "off label." 80% of prescriptions for gabapentin are used off label. It is approved for partial seizures and post herpetic neuralgia (PHN). The new formulations (Gralise and Horizant) are not interchangeable with gabapentin.
Are alpha blockers recommended for "first line" use in patients with HTN?
No.They are used more for BPH. They can be used first line for a "therapeutic twofer" such as in a patient that has HTN and BPH
What are the two types of pain?
Nociceptive and neuropathic
Diuretics should be given in the AM to avoid _____________?
Nocturia
Verapamil
Non Dihydropyridine calcium channel blocker
What is the leading cause of re-hospitalization in patients with HF
Non adherence with diet and medications
Which of the alpha blockers are nonselective and can cause vasodilation in the blood vessels that contributes to hypotension?
Non selective alpha blockers include doxazosin (Cardura) and terazosin (Hytrin)
What is the significance of non-HDL, according to the National Lipid Association?
Non-HDL represents the remaining atherogenic particles. The NLA recommends treating until LDL-C and non HDL-C are at goal
What is "non HDL-C"?
Non-HDL-C is the total cholesterol minus the HDL-C. The NLA uses non-HDL levels as a target. The The ACC/AHA does not.
An individual with epilepsy has breakthrough seizures. The most likely cause is:
Nonadherence
What is the major reason for treatment failures in patients treated with AEDs?
Nonadherence
contributing factors to resistant or refractory HTN
Nonadherence, interfering substances, inappropriate drug regimes, occult volume overload, white coat HTN, obesity, obstructive sleep apnea (OSA) and secondary causes of HTN such as thyroid disease, adrenal disease, or renal disease.
Which CCBs should be avoided in patients with HF?
Nondihydropyridine CCBs because they are negative inotropes (diltiazem and verapamil)
Labetalol (Trandate, Normodyne)
Nonselective Beta Blocker
May lead to bronchoconstriction
Nonselective Beta Blocker
Inderal
Nonselective Beta Blocker Mask the s/s of hypoglycemia
InnoPran
Nonselective Beta Blocker Mask the s/s of hypoglycemia
Propranolol
Nonselective Beta Blocker Mask the s/s of hypoglycemia
What type of anemia is anemia of chronic disease?
Normocytic, normo-chromic
Inhaled nasal corticosteroids are the most effective drugs used to treat allergic rhinitis. Describe the proper technique to administer nasal corticosteroid sprays.
Nose to toes and spray towards the ears.
Does Medicare reimburse for ambulatory BP monitoring?
Not always
Is tardive dyskinesia reversible?
Not always
Are SSRIs helpful for pain management?
Not really
Are opioids helpful for neuropathic pain?
Not really
Does tramadol cause respiratory depression?
Not really
Has niacin been shown to reduce morbidity and mortality related to ASCVD?
Not really according to the AIM-HIGH study
Does fluoxetine (Prozac) need to be tapered?
Not really because it has such a long half-life
Can pregnant women and newborns use sulfonamides?
Not recommended
How would you advice a pregnant mother regarding the use of a BZD?
Not recommended. BZDs are Pregnancy Category D and X.
Since January 2009, to protect the ozone, all inhalants used in the treatment of asthma must be HFA's. Are spacers required with DPIs or the new HFA inhalers?
Not required however spacers used with HFAs increase drug delivery to the lungs
Can children articulate being short of breath?
Not very well. "My chest hurts, the air is thick or more commonly, I feel fine" are sometimes heard in children having difficulty breathing.
Give examples of foods high in potasium
Nuts, dried food, spinach, citrus fruits, potatoes, bananas, salt subsitute
Give examples of foods high in potassium.
Nuts, dried food, spinach, citrus fruits, potatoes, bananas, salt substitute
Describe the CNS effects of an excessive dosage of phenytoin
Nystagmus, sedation, ataxia, diplopia and cognitive impairment.
Name a few drugs that can increase the risk of vaginal candidiasis
OCs, glucocorticoids, anticancer drugs, immunosuppressants, & antibiotics
Orlistat (Xenical, Alli) inhibits absorption of dietary fat. Which of the following statements is true:
Oily fecal leakage can occur
Which antipsychotic agents are approved for major depression?
Olanzapine (Zyprexa) and aripiprazole (Abilify)
Why is it important to use lower doses of diuretics in older adults?
Older adults are more susceptible to hypovolemia, hypotension, dizziness, and electrolyte imbalances
Which of the alpha-adrenergic antagonists can cause vasodilation in the blood vessels that contributes to hypotension as well as relaxation in the bladder neck and prostatic capsule?
Older alpha-adrenergic antagonists include prazosin (Minipress), doxazosin (Cardura) and terazosin (Hytrin)
Patients with acute depression should not be given more than a _____week supply of TCAs?
One
How is syphilis treated?
One dose of Penicillin G 2.4 million units IM
When should PPI's or H2 blockers be taken when taking ketoconazole?
One hour before or two hours after taking ketoconazole
Which of the following statements are true regarding the use of Protein Pump Inhibitors (PPIs)?
One hour prior to meals is the best time to take PPIs PPIs are associated with increased risks of infection and fractures Clopidogrel may be less effective when used with PPIs PPIs are the most effective drugs for suppressing gastric acid secretion
When are trough levels drawn for serum antibiotic levels?
One hour prior to next dose
P Glycoprotein
One transporter, known as P-glycoprotein (PGP) or multidrug transporter protein is a transmembrane protein that transports a wide variety of drugs out of cells.
24% of the adult population has HTN with 53% receiving treatment. What is the percentage of these patients succeeding in meeting blood pressure treatment goals?
Only 14-25% reach treatment goals
What is the definition of a family history of premature ASCVD?
Onset <55 years of age in a first degree male relative or <65 years of age in a first degree female relative - first degree relative includes parents, sibling, or children; second degree relative includes grandparent, grandchildren, aunt, uncle, niec
Why does Serevent have a Black Box Warning?
Onset is delayed and if used incorrectly as a rescue inhaler, death can occur.
Respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression and biliary colic are all adverse effects of___________?
Opioid agonists
Naloxone
Opioid antagonist
Naloxone (Narcan) is an example of an____________?
Opioid antagonist or reversal agent
What type of analgesics are the most effective?
Opioids
Codeine and hydrocodone suppress cough by (decreasing or elevating) the threshold.
Opioids elevate the cough threshold
Patients with severe asthma exacerbation are usually treated with bronchodilators and __________glucocorticoids?
Oral
Delayed and or persistent symptoms of anaphylaxis can be treated with _________?
Oral glucocorticoids
Warfarin (Coumadin)
Oral long term anticoagulation therapy Used for long-term prophylaxis of thrombosis
How long is the treatment for onychomycosis?
Oral therapy (terbinafine -Lamisil) can last for 3 months or longer
Why are the elderly are more sensitive to drugs?
Organ dysfunction, polypharmacy, comorbidities, cognitive decline.
What drugs are approved for long-term weight loss?
Orlistat (Xenical)
What is the most common adverse effect of inhaled glucocorticoids (ICSs)?
Oropharyngeal candidiasis and dysphonia (hoarseness, speaking difficulty).
Older adults should avoid the older alpha blockers such as doxazosin, prazosin, and terazosin because of the risk of:
Orthostatic hypotension leading to the risk of falls
What are the common adverse effects of TCAs?
Orthostatic hypotension, sedation, and anticholinergic effects.
Women on ICSs or oral glucocorticoids may not absorb calcium as well and are at risk for_____________?
Osteoporosis
Why do high triglycerides lead to pancreatitis?
Outflow of pancreatic enzymes occurs with excessive levels of triglycerides leading to inflammation and auto-digestion of the pancrease
What setting do most of the drug errors occur?
Outpatient or ambulatory settings.
Define the term parenteral?
Outside the GI tract. (i.e. given by injection as in IV, Sub-Q, or IM).
At what rate should IV meds be administered?
Over one full minute.
How is intravenous furosemide (Lasix) administered?
Over one to two minutes
Phenytoin can also cause hirsutism? Define hirsutism.
Overgrowth of hair in unusual places
A BMI of 28 is considered ________________?
Overweight
Examples of Anticholinergic Drugs
Oxybutynin (Detrol) Ipratropium (Atrovent) Tiotropium (Spiriva)
What is the underlying cause of angina?
Oxygen supply to the heart is insufficient to meet oxygen demand.
What are the disadvantages of using clarithromycin?
P450 inhibition causes dangerous drug interactions
What is the advantage of patient controlled anesthesia (PCA)?
PCA provides protection against pain recurrence.
A dangerous lowering of blood pressure can occur when alpha blockers are used with_______?
PDE5 inhibitors such as sildenafil (Viagra)
What occurs if PPI's or H-2 blockers are used with ketoconazole?
PPI's and H2 blockers can reduce the absorption of ketoconazole
How do proton pump inhibitors (PPIs) promote ulcer healing?
PPIs inhibit H+, K+-ATPase, the enzyme that generates gastric acid.
What is the name of the laboratory test used to monitor warfarin levels?
PT INR is used to monitor warfarin therapy
What are the uses for histamine-2 receptor simulation?
PUD and GERD
What are the GI causes of blood loss?
PUD, use of NSAIDs, and colon cancer
Define akathesia.
Pacing and squirming.
Define allodynia.
Painful responses to normally innocuous stimuli.
What can occur when triglycerides are elevated above 500 mg/dL?
Pancreatitis
Which PPI has the least problems when combined with clopidogrel
Pantoprazole (Protonix)
A patient presents with a blood pressure of 210/124 mm HG. The nurse examines the patient looking for signs of end organ damage. Which of the following findings represent end organ damage and a hypertensive emergency requiring hospitalization:
Papilledema (edema of the retina) Change in mental status Congestive heart failure Chest pain
Rarely BZDs can cause insomnia, excitation, euphoria, anxiety and rage. This is known as a_____________reaction?
Paradoxical
Stimulation of the (sympathetic or parasympathetic) system has the following effects on these organs: Heart-slows Stomach- salivation, increased gastric secretions Bowel and bladder- increased intestinal tone and motility, defecation Eye- constriction Lung- constriction of bronchi Sweat glands- generalized sweating Blood vessels- vasodilation
Parasympathetic system
Another name for muscarinic agonist is:
Parasympathomimetic agents
State another name for muscarinc agonists?
Parasympathomimetics
Which class of antibiotics is used to treat serious hospital infections due to aerobic gram-negative bacilli such as Pseudomonas aeruginosa, E-coli, Klebsiella, Serratia, and Proteus mirabilis?
Parenteral aminoglycosides
____________ is characterized by bradykinesia, mask-like faces, drooling, tremor, rigidity, shuffling gait, cog-wheeling, and stooped posture.
Parkinsonism
A patient with depression has insomnia and a BMI of 18. Which agent would be the most appropriate choice?
Paroxetine (Paxil)
Which SSRI has anticholinergic effects, can cause sedation, and weight gain
Paroxetine (Paxil)
Select the 2 SSRIs that have the highest incidence of drug-drug reactions.
Paroxetine (Paxil) Fluoxetine (Prozac)
Which SSRI can be a problem in an elderly male because of anticholinergic effects?
Paroxetine can exacerbate BPH and lead to urinary obstruction
A seizure that begins focally in the cerebral cortex and undergoes limited spread to adjacent cortical areas is known as a _______________seizure?
Partial seizure
Test used to monitor treatment of heparin
Partial thromboplastin time (PTT)
What is a "blinded" study?
Participants don't know if they belong to the control or experimental group.
What is the name of the tool commonly used to assess depression in Primary Care?
Patient Health Questionnaire (PHQ-9)
What is the metabolic syndrome?
Patients having any 3 of the following criteria are at high risk for developing pre-diabetes or diabetes: elevated waist circumference greater than or equal to 37 inches in men and 32 inches in women; elevated triglycerides greater than or equal to
A patient is scheduled for cataract surgery and the surgeon wants to know it the patient is on an alpha blocker or has ever been on an alpha blocker. Why is this important to know?
Patients that have been on alpha blockers require special equipment in the operating room during cataract surgery because alpha blockers can cause floppy iris syndrome.
What types of HTN patients will benefit from BB therapy?
Patients who have CHF, asymptomatic LV dysfunction,and a history of MI
Because of potential of overdose, who should not be treated with TCAs?
Patients who have suicidal ideations. The lethal dose is only 8 times the average therapeutic dose.
What types of disorders would require caution when prescribing oral corticosteroids?
Patients with DM, schizophrenia or other mental illnesses, and PUD
Which of the 4 groups have the recommendation of treatment with moderate intensity statins to lower LDL-C >30-50%?
Patients with DM; patients with a risk of ASCVD of 7.5% or greater using the Pooled Cohort equation
Blood pressure medications are often chosen based on compelling indications. What does this mean?
Patients with comorbid conditions benefit from specific drugs. ACEI of ARB for patients with DM; BB for patients with ASCVD or HF, diuretics for patients with osteoporosis and so on
Which patients with HTN should be admitted to the hospital?
Patients with evidence of end organ damage
Are there ever reasons for a patient with DM to be on a beta blocker?
Patients with heart disease and diabetes often require beta blocker
What is the role of vitamin D in the treatment of asthma?
Patients with higher levels may respond better to ICS
Patients with asthma are asked to monitor ________ because if the value is less than 80% of their personal best, more frequent monitoring and changes in medical therapy should be done.
Peak expiratory flow rates (PEF)
Latent syphilis is treated with 3 weekly doses of _______?
Penicillin G 2.4 million units IM
Which antibiotics have a beta lactam ring and are considered "beta-lactam antimicrobials?
Penicillins, cephalosporins, & carbapenems are beta-lactam antimicrobials
A patient is known to abuse opioids presents to the ED with pain. Which pain medication should not be given to prevent an opioid withdrawal syndrome?
Pentazicine (Talwin)
Give an example of a partial agonist.
Pentazocine (Talwin).
What are the adverse effects of isoniazid INH?
Peripheral neuropathy, hepatotoxicity, optic neuritis, and CNS effects
Statins are recommended for patients at high risk of thromboembolic events. Which of the following conditions are considered "cardiac risk equivalents" and require LDL levels lowered by 50%:
Peripheral vascular disease Diabetes Abdominal aortic aneurysm Cerebral vascular accident (CVA)
What type of anemia occurs with impaired B12 absorption due to a lack of intrinsic factor?
Pernicious anemia
A patient with diminished kidney function is prescribed a drug that rises to levels higher than desired. This is an example of:
Pharmacokinetics
The FDA required the makers of Chantix to add warnings of mood changes. These adverse effects became known after the drug was released for general use. Which phase of clinical testing did this occur?
Phase IV Postmarketing Surveillance
Sedation, respiratory depression, exacerbation of intermittent porphyria, physical dependance and interference with the metabolism of Vitamin D & are the major side effects from which AED used to treat seizure disorder?
Phenobarbital
Name a drug that is an inducer.
Phenobarbital and phenytoin and St. John's wort.
Which drug is used to minimize tissue injury resulting from extravasation of dopamine infusion?
Phentolamine
What is the treatment for extravasation of an alpha1 agonist?
Phentolamine (alpha adrenergic antagonist)
Which AED can cause hursitism?
Phenytoin
Give examples of drugs known as inducers
Phenytoin, phenobarbital, St. John's wort.
Other than BPH, what are some other less common indications for the use of alpha blockers?
Pheochromocytoma and Raynaud's disease
Why should patients taking antipsychotics be advised to avoid sun exposure?
Photosensitivity leading to sunburn is a possibility
What are non-pharmacologic measures that can be used to treat PD?
Physical and occupational therapy, exercise, dance and deep brain stimulation which is only done in research centers
The component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug is known as what?
Placebo effect.
Which of the following statements are true regarding phenytoin:
Plasma drug levels between 10-20 mcg/mL are ideal Rapid administration can cause cardiovascular collapse The half-life varies with dosage due to saturation kinetics (the half-life is extended with increased doses)
What effect does Lovaza or fish oil supplementation have on platelet function?
Platelet function can be impaired leading to increased risk of bleeding.
A patient has an immune response to heparin and develops heparin induced thrombocytopenia. The nurse knows to check which of the following:
Platelets
Amiodarone is a potassium channel blocker used for dysrhythmias including atrial fibrillation even though it is not approved for treatment of AF. Which of the following adverse effects are seen with this drug:
Pneumonitis Hyperthyroidism Hypothyroidism Cough Optic neuropathy Dysrhythmias
What causes postural (orthostatic) hypotension?
Pooling of blood in veins that decreases venous return and decreases cardiac output
Can antidepressants contribute to memory issues?
Possibly
Can fatty fish or consuming fish oil supplements reduce heart dysrhythmias such as atrial fibrillation?
Possibly
Is a cephalosporin a viable option for a patient with a mild PCN allergy?
Possibly, however, not worth the risk in most cases.
Newer antiepileptic drugs such as oxcarbazepine (Trileptal) and lamotrigine (Lamictal) are better tolerated than older agents. Are they safer in pregnancy?
Possibly. The lowest possible dose should be prescribed.
Give examples of neuropathic pain.
Post herpetic neuralgia (PHN), diabetic neuropathy, and cancer pain
What are the cardiovascular effects of levadopa used to treat PD?
Postural hypotension and dysrhythmias. The cause of the hypotension is unknown.
State the adverse effects related to vasodilation.
Postural or orthostatic hypotension, reflex tachycardia, fluid retention.
What are the guidelines for initiating an aldosterone blocker in respect to potassium levels and kidney function?
Potassium must be less than 5.0 mEq/dL without history of hyperkalemia. Serum Cr should be less than 2-2.5 mg/dL or CrCl less than 30 mL/min
Which drug is used for restless leg syndrome?
Pramipexole (Mirapex)
"Sleep attacks" are associated with___________?
Pramipexole (Mirapex) which is a dopamine agonist
Which drug is the prototype for the category of dopamine agonists?
Pramipexole (Mirapex). Ropinirole (Requip) is also used
What age is appropriate for initiation of statin therapy in children with familial hypercholesterolemia?
Pravastatin is approved down to age 8 years. All other statins are approved for use in children age 10 and older.
Which drug blocks the alpha receptors in the prostatic capsule and can alleviate symptoms in men with benign prostate hypertrophy (BPH)?
Prazosin
Which of the alpha blockers were developed as antihypertensive agents first and then later used for BPH?
Prazosin (Minipress), doxazosin (Cardura) and terazosin (Hytrin)
Alpha adrenergic antagonist prototype and MOA
Prazosin (minipress): Blocks alpha 1 receptors, dilates arteries and veins, relaxes smooth muscle in the bladder neck and prostatic capsule.
Locaserin (Belviq) suppresses appetite by being an agonist at 5-HT2c receptors. It is a scheduled drug and can lead to serious side effects. It is contraindicates in______________?
Pregnancy
Which of the conditions listed below are contraindications for the use of ACE inhibitors and ARBs:
Pregnancy Bilateral renal artery stenosis History of angioedema to ACE inhibitor or ARB
What are the major risk factors for vaginal candidiasis?
Pregnancy, obesity, diabetes, debilitation, & HIV infection
The USPSTF recommends HIV screening for which of the following individuals or groups
Pregnant women All individuals between the ages of 15 and 65 years
Depo Preparation
Preparations from which the drug is absorbed slowly over an extended time
What are depot preparations?
Preparations from which the drug is absorbed slowly over an extended time.
Where are Alpha2 receptors located?
Presynaptic nerve terminals
What is the advantage of depot antipsychotic preparations?
Prevent relapse and maintain the highest possible level of functioning
Antagonists (activate or prevent) receptor activation?
Prevent.
Name 3 applications for antiplatelet therapy
Prevention of 1st MI, reinfarction, and stroke in patients with a hx of TIAs.
What are the indications for dabigatran?
Prevention of stroke and thromboembolism in patient with AF, DVT/PE prophylaxis,
Phentolamine is a non-selective alpha blocker that blocks alpha1 and alpha2 receptors. The most common use is:
Prevention of tissue necrosis following extravasation of drugs that produce vasoconstriction such as epinephrine
What are the two types of HTN?
Primary (no identifiable cause) and secondary which has an identifiable cause
What are the absolute contraindications for using "clot busting" drugs?
Prior intracranial hemorrhage, known cerebral vascular lesion or neoplasm, ischemic stroke within last 3 months, active bleeding, suspected aortic dissection
What are some of the "premotor" signs that occur with PD that are associated with autonomic dysfunction occurring with dopamine deficiency outside of the brain?
Problems with speech, depression, decrease in olfactory senses, sleep disturbances
Class I antidysrhythmic drugs decrease conduction velocity in the atria, ventricles, and His-Purkinje system by blocking sodium channels. Which of the following is classified as a Class 1 agent:
Procainamide
Antagonist
Produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs
What are the signs of muscarinic poisoning?
Profuse salivaton, tearing, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension (Mr. Pathetic)
What can occur when megaloglastic anemia is correceted by the administration of folic acid, and the B12 deficiency is masked?
Progressive neurological damage can occur if B12 deficiency is uncorrected
The main therapeutic effect from a muscarinic agoinst such as bethanechol is:
Promotion of urination
Medication overuse headache (MOH) or rebound headache is the result of over use of medication for headaches. Patients using abortive therapy more than 2-3 times a week should be considered for _______________ treatment?
Prophylactic treatment with possibly a beta adrenergic antagonist.
What are the uses for osmotic diuretics such as mannitol?
Prophylaxis of renal failure, reduction of intracranial pressure, and reduction of intraocular pressure
Class II antidysrhythmic drugs decrease automaticity of the SA node, decrease velocity of conduction through the AV node, and decrease myocardial contractility. Which of the following are in this class:
Propranolol
Which beta blocker has indications for migraine prophylaxis?
Propranolol
A patient with three or more severe migraines a month may need daily prophylactic medication. Which of the following medications are used to prevent migraines?
Propranolol Divalproex (Depakote ER) Topiramate (Topamax) Amitriptyline
Beta adrenergic antagonists: 1st generation non-selective prototype and MOA
Propranolol: Blocks Beta 1 and Beta 2 receptors
Used for over dosage of heparin
Protamine Sulfate
What is the antidote for severe heparin overdose?
Protamine sulfate
How long does it take neutralization of heparin to occur?
Protamine works immediately and lasts for 2 hours.
Which class of antiretroviral medications can lead to hyperglycemia/diabetes, fat maldistribution, hyperlipidemia, reduced bone density, hepatotoxicity, and drug interactions?
Protease inhibitors
Lipoproteins carry cholesterol and triglycerides. Density of the lipoprotein is determined by the amount of _________ carried by the lipoprotein
Protein
Protein or albumin is (higher or lower) in an infant which might lead to (increased or decreased) levels of a drug bound to protein?
Protein or albumin is lower in infants leading to increased levels of drugs beccause there is less albumin to bind to. When bound to albumin the drug is inert.
Test used to monitor treatment of warfarin
Prothrombin time (PT) & International normalized ratio (INR)
Clopidogrel is an antiplatelet drug that used to prevent blockage of coronary artery stents and to reduce thrombolic events in patients with CAD. Some patients have gene varients and do not respond to clopidogrel. A certain class of drugs can reduce the benefis of clopidogrel by inhibiting the hepatic enzyme that coverts clopidogrel to its active form. Which class of drugs has this effect:
Proton pump inhibitors (PPIs) such as omeperazole
Why are iron dosages evenly spaced throughout the day?
Provides the bone marrow with a continuous Fe supply, maximizing RBC production
A patient on an ACE inhibitor is found to have an elevated serum potassium. The nurse provides a list of foods high in potassium to avoid. Which of the following has the highest potassium content?
Prunes
What is the nebulized inhaled corticosteroid approved for use in children?
Pulmicort Respules
What are some of the other adverse effects of amiodarone?
Pulmonary, cardiovascular, thyroid, liver, dermatologic, and fetal toxicity. CNS and GI effects are common. Drug interactions are of concern. Look in ePocrates for Boxed Warning.
What would be important to assess in a patient with sustained ventricular tachycardia being treated with Quinidine?
QRS widening and QT prolongation
First generation antipsychotics such as haloperidol, thioridazine, and pimozide post a risk of fatal cardiac dysrhythmias due to________________?
QT prolongation
What was the recent (2012) warning regarding the use of azithromycin?
QT prolongation
Patients with PD often require antipsychotic medications when psychosis occurs. Many of the antipsychotic drugs block dopamine and can cancel out the efficacy of the dopaminergic drugs. Two antipsychotics block dopamine outside of the substantia nigra and can be used. Name the 2 antipsychotics recommended for treatment of psychosis in patients with PD.
Quetiapine (Seroquel) and clozapine which is not recommended due to AE and required REMS due to serious hematologic adverse effects.
Which of the atypical antipsychotics is the most sedating and can also lead to cataracts?
Quetiapine (Seroquel). Also know as "baby heroin" or "quell" or "Suzi Q"
Quinidine (Class 1: sodium channel blocker) has what effects on EKG?
Quinidine has two pronounced effects on the ECG. The drug widens the QRS complex (by slowing depolarization of the ventricles) and prolongs the QT interval (by delaying ventricular repolarization).
What are some of the conditions that can cause anemia of chronic disease?
RA, osteoarthritis, SLE, and diabetes
A patient with diabetes presents with hypertension. The antihypertensive drug of choice is:
Ramipril
Albuterol (Proventil, Proventil HFA and Ventolin HFA), levalbuterol (Xopenex, Xopenex HFA), and pirbuterol (Maxair) can all be used as rescue inhalers because their onset of action is_____________?
Rapid
First- Pass
Rapid hepatic elimination of a drug without achieving its therapeutic effect
What are the therapeutic uses of high-ceiling (loop) diuretics?
Rapid mobilization of fluids to treat pulmonary edema, heart failure, HTN
Many AEDs are used for other reasons such as treatment of BPD. A Black Box Warning includes the development of a serious___________?
Rash
What is the problem with using topical sympathomimetic nasal decongestants like Afrin for more than a few days?
Rebound congestion can occur
What is the problem with using topical sympathomimetic nasal decongestants like Afrin?
Rebound congestion develops when used for more than a few days.
Why is it important to taper clonidine gradually when discontinuing therapy?
Rebound hypertension can occur
Why do beta blockers need to be tapered?
Rebound tachycardia occurs and can be problematic in patients with heart disease
What is the problem with patients with diabetes and concurrent use of beta blockers?
Recognition of hypoglycemia may be diminished in patients with beta blockade
Suppository
Rectal suppositories may be employed for local effects or for effects throughout the body. Vaginal suppositories may be employed to treat local disorders.
What is the RDW?
Red cell distribution width-differences among the sizes if the RBCs
What is the name of the dietary supplement used to lower cholesterol that contains lovastatin and is not regulated by the FDA?
Red rice yeast
What can orlistat due to levothyroxine if given simultaneously
Reduce the effect
What signs of liver injury would you describe in teaching your patient about the adverse effects of valproic acid?
Reduced appetite, malaise, nausea, abdominal pain and jaundice.
Blocking of beta1 receptors in the heart lead to:
Reduced heart rate, reduced force of contraction, and reduced AV conduction
How do BBs lower blood pressure?
Reduction of peripheral vascular resistance, decreasing myocardial contractility, suppressing reflex tachycardia and decreasing renin release (through beta1 blockade in the kidney)
Explain how reentry produces dysrhythmias?
Reentry causes dysrhythmias by establishing a localized, self-sustaining circuit capable of repetitive cardiac stimulation.
What happens when beta blockers are withdrawn abruptly?
Reflex or rebound tachycardia that can lead to angina and MI.
Aldosterone blockers are indicated for the treatment of heart failure. These drugs are thought to decrease the pathological effects of the heart and decrease ____________?
Remodeling
What occurs when sodium levels are low in patients taking lithium?
Renal excretion of lithium is reduced causing lithium levels to rise.
What complication occurs in the event of rhabdomyolysis from statin therapy?
Renal failure can occur as large molecules of protein from muscle breakdown clog the glomeruli and damage the kidney.
What treatment is the most effective way to preserve myocardial function and limit myocardial infarct size?
Reperfusion therapy with thrombolytics.
Describe the clinical manifestations of BZD IV overdose.
Respiratory and cardiac arrest
Why is meperidine preferred during childbirth for pain relief?
Respiratory depression is less likely than with morphine
Promethazine (Pherergan) suppresses emesis by blocking the dopamine2 receptors in the CTZ. It is contraindicated for use in children under the age or 2 and should be used with caution in children older than 2. What is the reason for this warning?
Respiratory depression leading to death
A patient taking simvastatin is precribed a macrolide antibiotic that is a strong CYP 3A4 inhibitor. The end result of this drug combination can be:
Rhabdomyolysis
Which dietary supplements are recommended for migraine prophylaxis?
Riboflavin 400 mg daily, magnesium 400 mg/day, Coenzyme Q-10, butterbur, and feverfew. Beware that dietary supplements are poorly regulated in the U.S.
Which antituberculin drug changes the color of tears, sweat, and urine?
Rifampin turns body secretions a red-orange color
Use of ARNI can cause lithium levels to (rise or fall)?
Rise-same as with ACEI or ARBs
What is REMS?
Risk Evaluation and Mitigation Strategy is imposed by the FDA on some drugs to decrease the risk of serious reaction.
Why would you recommend discontinuation of an aldosterone blocker if the loop diuretic was interrupted?
Risk of hyperkalemia
What is a newer FDA warning regarding leukotriene antagonists?
Risk of psychiatric side effects such as depression and suicidality
Which of the following lipid lowering drugs has the greatest ability to lower LDL:
Rosuvastatin
Which statin has the highes risk for myopathy?
Rosuvastatin (Crestor) in high doses may pose the highest risk of rhabdomyolysis
Trace an impulse through the myocardium
SA-AV-BOH-R and L Bundle Branches-Purkinje fibers
Why is Salmeterol (Serevent) never used as a "rescue" medication?
SABAs such as albuterol (Proventil, Proventil HFA, & Ventolin HFA), levalbuterol (Xopenex, Xopenex HFA), & pirbuterol (Maxair) --> rescue.
Patients with gene variants of HLA-B* 1502 on AEDs are more susceptible to:
SJS/TEN
What types of agents are helpful for neuropathic pain?
SNRIs, TCAs, AEDs, and anesthetics such as lidocaine
Fluoxetine
SSRI
Name a few drugs that have a Black Box Warning.
SSRI's, antipsychotics, metformin, & salmeterol have black box warnings.
Sexual dysfunction, nausea, headache, insomnia, anxiety, weight gain, serotonin syndrome, withdrawal syndrome, and neonatal withdrawal syndrome are all adverse effects of __________________.
SSRIs
What are the principal drugs used to treat anxiety?
SSRIs and NSRIs are preferred. Bzds are used as adjunctive therapy.
What is the MOA of sacubitril
Sacubitril is a new drug that blocks the enzyme the breaks down natriuretic peptides. It is used in combination with and ARB for the treatment of heart failure
A drug with a high therapeutic index is considered (safe or unsafe)?
Safe.
Advair inherited a Black Box Warning because of the __________component of the combination drug.
Salmeterol
Long-Acting Beta Agonists LABA
Salmetrol
Name substances or drugs that can increase the risk of hyperkalemia when used with DRIs
Salt substitutes, potassium supplements, avocado, ACEIs, and ARBs
Which scheduled drugs can not be called into the pharmacy and require a hard copy?
Schedule II drugs.
Benzodiazepines are Schedule_________ drugs?
Schedule IV drugs.
Slowly progressing symptoms, malaise, muscle aches, sore throat, low-grade fever with non productive cough are symptoms of atypical organisms causing pneumonia. This is most common in which age group?
School age to adolescents
Clozapine
Second generation antipsychotics
What is the effect of histamine-2 receptor stimulation
Secretion of gastric acid
What are the side effects of BZD's?
Sedation, physical dependence, and withdrawal syndrome.
What type of agent is zolpidem (Ambien)?
Sedative hypnotic agent.
The prototype MAO-B inhibitor used "first-line" for PD is_______?
Selegiline (Eldepryl, and rasagiline (Azelect)
Which agents used to treat migraine headaches release inflammatory neuropeptides that diminish perivascular inflammation and cause vasoconstriction by binding to 5-HT 1B/1D receptors?
Serotonin 1B1D- receptor agonists known as "triptans"
Sumatriptan
Serotonin Receptor Agonist
Tramadol (Ultram) is an analog of codeine and weak agonist at the mu receptors. It also blocks reuptake of_______________?
Serotonin and norepinephrine
Disorientation, agitation, confusion, anxiety, hallucinations, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor and fever are all symptoms of __________________?
Serotonin syndrome
Meperidine has serotonergic properties. If mixed with TCAs, SSRIs, and triptans, it can lead to_____________?
Serotonin syndrome
What is the problem with the combination of SSRIs and triptans?
Serotonin syndrome can result due to excessive sertonergic activity.
Which SSRI associated with a higher incidence of GI distress?
Sertraline
Why is creatinine clearance important in the elderly more so than serum creatinine?
Serum creatinine does not acurately reflect kidney function in the elderly
What are the symptoms of antibiotic associated pseudomembranous colitis (AAPMC)?
Severe diarrhea with 10-20 watery stools/day, fever, & abdominal pain
the differences between a hypertensive urgency and a hypertensive emergency
Severe elevation >180/120 without symptoms or evidence of acute end-organ damage indicates urgency. Presence of end organ damage constitutes a HTN emergency
What is acute dystonia?
Severe spasms of the muscles in the tongue, face, neck or back.
What is the "silent chest?"
Severely reduced air flow during an asthma exacerbation
What are the four S's of PD?
Shaky, slow stiff and stumbling
Ghost Capsules
Shell of extended release tablet often seen in the stool. False appearance of passing an intact tablet in stool.
What are the uses for drugs that activate alpha1 receptors?
Shock and for treatment of nasal congestion.
How long does it take to achieve maximal benefits with the use of inhaled glucocorticoids?
Short term effects may be evident in 3-4 days. Maximum benefit takes 4-6 weeks.
Why are alpha2 agonists such as clonidine on the Beer's list?
Side effect such as CNS effects, bradycardia, hypotension outweigh the benefits
Which alpha blocker would be appropriate for a normotensive male with BPH?
Silodosin (Rapaflo) or Tamsulosin (Flomax)
Which alpha-adrenergic antagonist would be appropriate for a normotensive male with BPH because the blockade of vascular alpha1 receptors is weak?
Silodosin (Rapaflo), tamsulosin (Flomax) or alfuzosin (Uroxatral) are new agents that cause "selective" blockage of alpha1 receptors in the prostate
Which statins should be avoided in patients concurrently being treated with protease inhibitors
Simvastatin lovastatin
Which scheduled drugs can NPs prescribe in the state of Florida?
Since 2017 NPs have prescriptive authority for controlled substances
How does montelukast (Singulair) help treat asthma symptoms?
Singular blocks leukotrienes (inflammatory mediators similar to histamine)
The rate of drug absorption in the elderly is (slow or accelerated)?
Slow.
Where in the abdomen is most of the iron absorbed?
Small intestine
What is the MOA of protamine sulfate?
Small protein groups bond ionically with the negative groups on heparin.
At what age would you expect a child to be able to perform spirometry to diagnosis asthma?
Some 5-6 year olds are able to perform spirometry properly.
Why are women with seizure disorders treated with vitamin K during the last few weeks of pregnancy?
Some AEDS reduce the levels of vitamin K - dependent clotting factors by inhibiting hepatic enzymes. This increases the risk of bleeding. The newborn should also be given an IM injection of vitamin K at birth.
Inhaled Formulations
Some drugs are inhaled to elicit local effects in the lungs, especially in the treatment of asthma.
Rosuvastatin can lower LDL by 60%. Why is LDL lowered more by certain agents?
Some of the statins have longer half lives and LDL is lowered more
When is the best time of day to administer statins?
Some statins are though to work best at night because cholesterol synthesis is more active in the liver at night. Long acting statins such as rosuvastatin and atorvastatin can be given at any time.
What are the major adverse effects of alpha2 adrenergic agonists?
Somnolence, hypotension and withdrawal response of rebound hypertension
When do side effects usually occur?
Soon after the onset of drug, or in some cases weeks or months afterwards.
The device used to treat asthma that serves the purpose to increase delivery of drugs to the lungs and decrease deposition of drug on the oropharyngeal mucosa is called a_____________?
Spacer
Which of the following diuretics can raise serum potassium levels?
Spironolactone (Aldactone)
Which diuretic is used for heart failure, HTN, treatment of hyperaldosteronism, and is also used to counteract the loss of potassium with the use of other diuretics?
Spironolactone (Aldalctone) or other potassium sparing diuretics such as triamterene
Name the two aldosterone antagonists
Spironolactone is the older agent. Eplerenone is a more selective aldosterone antagonists and has less side effects
Name the herbal supplement that induces the metabolism of protease inhibitors. This leads to reduced blood levels of the protease inhibitors and diminished efficacy.
St. John's Wort
Which herbal remedy is an inducer and can decrease the levels of warfarin, cyclosporine, oral contraceptives and antiretroviral medications?
St. John's wort
For eGFR in women, multiply equation by 0.85. Normal GFR is greater than 90 mL/min in women and greater that 100 mL/min in men. The National Kidney Foundation has established the following stages of chronic kidney disease (CKD):
Stage I: Proteinuria with normal GFR Stage II: GFR 60-89 mL/min/1.73 Stage III: GFR 30-59 mL/min/1.73 Stage IV: GFR 15-29 mL/min/1.73 Stage V: GFR 15 mL/min/1.73
What occurs when "azoles" are used with some of the statins (lovastatin & simvastatin)?
Statin levels rise to toxic levels increasing the possibility of rhabdomyolysis
Name a drug class that was formerly Category X that is used to treat hyperlipidemia.
Statins
When are statins contraindicated?
Statins are contraindicated in pregnancy or patients with liver dysfunction
Which class of lipid lowering drug has been associated with a slightly increased risk of developing diabetes?
Statins have been observed to slightly increase the risk of diabetes in patients with prediabetes or metabolic syndrome. The risk benefit ratio favors the use of statins inpatients with diabetes. Niacin can also elevate glucose levels.
How is familial hypercholesterolemia treated?
Statins have evidence for decreasing the lifelong effects of elevated LDL-C.
Which drug class lower triglycerides?
Statins, fibric acid derivatives, niacin, and fish oil
Withdrawal of AEDs must be done gradually to avoid:
Status epilepticus
Plateau
Steady level
ACE inhibitors are contraindicated in patients with renal artery _______?
Stenosis
Diethylpropion and phentermine are SNS__________that increase norepinephrine.
Stimulants
Which drugs are more effective for ADHD?
Stimulants
Muscarinic agonist
Stimulates Muscarinic rceptors
What are the therapeutic uses of misoprostol (Cytotec)?
Stomach ulcer, induction of labor
How is hyperkalemia treated?
Stop infusion of potassium replacement or intake of foods high in potassium.
The maximum dose of this drug is three tablets. If pain is not relieved in 5 minutes, the patient can take a second pill. The patient should call 911 or report to an emergency department. If angina pain does not respond it may indicate an MI. If the pain does not resolve with the second pill, a third pill can be taken while emergency care is in route. What medication is this?
Sub-lingual nitroglycerin.
Which of the following anti-ulcer drugs does not change the pH of the stomach?
Sucralfate
A genetic deficiency in G6PD can lead to hemolytic anemia because the red blood cells burst when exposed to which class of antibiotics?
Sulfonamides
Which class of antibiotics is associated with hypersensitivity, rash, drug fever, photosensitivity, hemolytic anemia and Stephens-Johnsons syndrome?
Sulfonamides
Which class of antimicrobials can cause hemolysis when given to patients with G6PD deficiency? Which ethnic groups have a higher incidence of G6PD Deficiency?
Sulfonamides can cause hemolysis and G6PD deficiency is most common in African Americans and people of Mediterranean origin
In addition to cardiac suppression and liver injury, itraconazole can cause elevations of which of the following drugs?
Sulfonylureas Digoxin Warfarin
Ipratropium is also recommended for cough. What is the MOA?
Suppresses cough by decreasing the sensitivity of respiratory tract stretch receptors
Benzonatate (Tessalon) is a structural analog of 2 local anesthetics: tetracaine and procaine. What is the MOA that suppresses cough?
Suppresses cough by decreasing the sensitivity of respiratory tract stretch receptors (Components of the cough-reflex pathway)
What are the four basic mechanisms by which AEDs control seizure activity?
Suppression of Na, Ca influx, blockade of glutamate, & potentiation of GABA.
A new infection which develops during the course of therapy for a primary infection, when antibiotics eliminate the inhibitory influence of normal flora is called a __________?
Supra infection
What are the uses for neuromuscular blocking agents?
Surgery and intubation
Is ezetimibe hepatotoxic or myotoxic?
Surprisingly, cases of liver toxicity and myositis have beenreported
What symptom of hypoglycemia would not be blocked in a patient on beta blocker therapy?
Sweating will occur during an episode of hypoglycemia because it is the muscarinic receptor activation that leads to sweating (no beta receptor influence)
Stimulation of the (sympathetic or parasympathetic) system has the following effects: Heart rate- increases Blood pressure- increases Skin-shunting of blood away from the skin and viscera and into skeletal muscles Bronchi- dilation of the bronchi Pupils- dilation Glucose levels- mobilization of stored energy to provide glucose for the brain
Sympathetic system
Stimulation of the (sympathetic or parasympathetic) system has the following effects: Heart rate- increases Blood pressure- increases Skin-shunting of blood away from the skin and viscera and into skeletal muscles Bronchi- dilation of the bronchi Pupils- dilation Glucose levels- mobilization of stored energy to provide glucose for the brain
Sympathetic system
Beta blockers also called beta adrenergic antagonists are considered to be (sympathomimetics or sympatholytics)?
Sympatholytics
Adrenergic agonists are also called (sympathomimetics or sympatholytics)?
Sympathomimetics
In individuals older than age 50 (systolic or diastolic) poses a greater cardiovascular risk?
Systolic
Elevated blood pressure or on treatment for hypertension
Systolic > 130 mm Hg and or diastolic > 85 mg Hg
What EKG changes occur with elevated potassium levels?
T wave heightens. PR interval prolongation can occur.
Amitriptyline
TCA
Describe the MOA of tricyclic antidepressants (TCAs).
TCA's block neuronal reuptake of norepinephrine and serotonin.
Anticholinergic and cardiotoxic symptoms including dysrhythmias i.e tachycardia, intraventricular blocks, complete heart blocks, ventricular tachycardia, and vetricular fibrillation are all toxic manifestations of which agents used to treat depression?
TCAs
MAO inhibitors, direct and indirect acting sympathomimetic drugs, anticholinergic agents and other CNS depressants including alcohol opioids, antihistamines, and barbiturates should be avoided while taking_______________?
TCAs
Name additional drug classes that have anticoholinergic effects?
TCAs, antipsychotics, and first generation antipsychotics
CA-MRSA skin infections can be treated with:
TMP-SMX, minocycline, and doxycycline, & clindamycin
A fixed dose combination antibiotic trimethoprim and sulfamethoxazole is known as___________________?
TMP-SMZ (Bactrim)
Why are TZDs contraindicated in heart failure?
TZDs (pioglitazone/Actos) causes weight gain and fluid retention that can exacerbate heart failure. Check in ePocrates for the Black Box Warning
What are the adverse effects of beta2 agonists such as albuterol?
Tachycardia
Selectivity to beta-2 receptors is lost at excessive dosing with beta 2 agonists and can cause can cause _____________?
Tachycardia and angina by activating beta-1 receptors in the heart.
What are the peripheral effects of sympathometic amines used for weight loss?
Tachycardia, angina, HTN, abuse, and a withdrawal syndrome
A form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time is known as what?
Tachyphylaxis.
Which drug used to treat AD can elevate the ALT?
Tacrine (Cognex) has been associated with liver failure and is rarely used
A patient with CAD has occasions to use his Nitrostat. He recently had an appointment with the urologist and asked for medications for sexual dysfunction. Which of the following medication would not be prescribed because of the risk of severe hypotension:
Tadalafil Sildenafil Vardenafil
The PDE5 inhibitors vary in their duration of action. Which PDE5 inhibitor has the longest half-life?
Tadalafil (Cialis)
How can insomnia be avoided when taking oral glucocorticoids?
Take entire dose in the AM.
Diluting liquid iron in water and fruit juice, administering with a straw or dropper and rinsing mouth after administration are all ways to prevent what?
Teeth staining after receiving liquid iron replacement therapy
What are some of the clinical manifestations of familial hypercholesterolemia other than overt ASCVD?
Tendon xanthomas, corneal arcus in an individual < 45 years of age, and eyelid xanthelasmas
Which antimicrobials form non-absorbable chelates with metal ions such as calcium, magnesium, iron, aluminum, and zinc and should not be taken with concurrently with these agents?
Tetracyclines
Which class of antibiotics has an effect on bone and teeth and should not be taken by children < 8 years of age and pregnant women or nursing mothers?
Tetracyclines
Which class of antibiotics is used to treat community acquired pneumonia, (CA-MRSA), rickettsial diseases, rocky mountain spotted fever, typhus fever, chlamydia, brucellosis, cholera, mycoplasma pneumonia, Lyme disease, anthrax, gastric infections (H. Pylori), acne, peptic ulcer disease, and peridontals disease?
Tetracyclines such as doxycycline and minocycline
Which antibiotics should not be taken during pregnancy?
Tetracyclines, fluoroquinolones, & chloramphenicol are not given in pregnancy
If a patient requires the use of a bronchodilator on a daily basis, what additional medication might be given to gain better control of their asthma?
The "rules of two" in reference to the use of beta-2 agonists in the treatment of asthma => If s/s occur > 2/week, a controller drug (ICS) for asthma is needed
Which patient is more likely to develop hepatotoxicity from INH (a 20 year old or a 52 year old)?
The 52 y/o due to advancing age and organ dysfunction
A list of drugs that have increased adverse events in the elderly and are not considered appropriate for use in the elderly is known as the _____________?
The Beers Criteria
Do statins cause cognitive impairment?
The FDA proposed this concern, however, evidence is minimal. Hydrophilic statins (pravastatin and rosuvastatin) may be tried in individuals that are concerned with cognitive effects related to statin use. The benefits of statins generally outweigh the risk of cognitive impairment.
Which Amendment strengthened drug regulation after the Thalidomide tragedy in Europe?
The Harris-Kefauver Amendment to the FDA and the Cosmetic Act of 1962.
Chronic Kidney Disease (CKD)
The National Kidney Foundation has established the following stages of chronic kidney disease (CKD): o Stage I: Proteinuria with normal GFR- sick endothelium o Stage II: GFR 60-89 mL/min/1.73 m3 o Stage III: GFR 30-59 mL/min/1.73 m3 o Stage IV: GFR 15-29 mL/min/1.73 m3 o Stage V: GFR 15 mL/min/1.73 m3 o MDRD (modification of diet and renal disease) formula is another alternative
Intrinsic Activity
The ability of a drug to activate the receptor following binding.
Bioavailability
The ability of a drug to reach the systemic circulation
Define automaticity?
The ability of the heart to initiate an action potential through self excitation
Where does aldosterone come from?
The adrenal cortex
What is the significance of pulses alternans?
The alteration of pulse pressure indicates severe impairment of LV function
Lethal Dose
The amount of a material, given all at once, which causes the death
Bioavailability
The amount of active drug that reaches the systemic circulation from its site of administration. Different formulations of the same drug can vary in bioavailability.
Potency
The amount of drug we must give to elicit an effect.
Define preload.
The amount of tension applied to a muscle before contraction. In the heart, stretch is determined by ventricular filling pressure also known as the force of venous return.
Define afterload.
The arterial pressure that the left ventricle must overcome to eject blood.
State the four systems that regulate arterial pressure.
The autonomic nervous system, RAAS, kidneys and natriuretic peptides
Which of the following is true regarding OTC drugs? (Choose all the apply)
The average home medicine cabinet contains 24 OTC preparations The FDA determines whether a drug is available by prescription or OTC
What is the purpose of the baroreceptor response?
The baroreceptors regulate blood pressure.
Why are neonates especially sensitive to drugs that affect the CNS?
The blood brain barrier is not fully developed at birth.
Which of the following statements is true about levodopa/carbidoa?
The carbidopa component is not metabolically active Movement disorders can occur with this drug Postural hypotension and dysrhythmias can occur this drug The effect can be decreased with concurrent use of drugs that block dopamine such as antipsychotic medications The drug often wears off after about 5 years Nausea and vomiting can occur early in treatment
ED50
The dose required to produce a therapeutic effect in half of the population.
ED50
The dose that is required to produce a defined therapeutic response in 50% of the population.
How is the first pass effect circumvented?
The drug bypasses the liver allowing it to go directly into blood stream when given parenterally.
The time required for the amount of drug in the body to decrease by 50% is called what?
The drug half-life.
Select the appropriate advise for medication administration to a nursing mother: (Choose all that apply)
The drug will be the highest for the baby when the drug peaks in the mother Dosing immediately after breast-feeding is the best Avoid drugs with a long half-life
What is the problem with giving patients with Parkinson's disease antipsychotics?
The drugs used to treat Parkinson's disease increase dopamine,the antipsychotics block, dopamine
Why is the use of levodopa/carbidopa delayed?
The effect is short lived and ill effects occur when the drug is used for an extended time period. This favors the initiation of other dopaminergics first.
Is CoQ10 helpful in patients with myalgias due to statins?
The evidence is not robust. It is not harmful.
Patients with Parkinson's disease (PD) have motor symptoms due to the loss of dopaminergic neurons in the substantia nigra. Which of the following statements is true regarding the neurochemical imbalance?
The excitatory influence of ACh is unopposed when dopamine is insufficient
Generic
The generic name of a drug is assigned by the United States Adopted Names Council. Each drug has only one generic name. The generic name is also known as the nonproprietary name. Generic names are less complex than chemical names.
What occurs when grapefruit juice and verapamil are taken together?
The grapefruit juice inhibits the metabolism of the verapamil and can increase the level of verapamil leading to hypotension, bradycardia, and toxicity
Describe Starling's law of the heart
The heart compensates to increases in blood volume by pumping more blood out
Describe Starling's law of the heart.
The heart compensates to increases in blood volume by pumping more blood out
Peak Level
The highest concentration of a drug in the patient's bloodstream.
Why does white coat HTN need close monitoring?
The incidence of stroke rises after 6 years
Where is renin produced?
The juxtaglomerular cells of the kidneys
Define afterload.
The load against which a muscle must overcome in order to contract. Medications that lower blood pressure can lower preload and afterload
Why is fluvastatin extended release (Lescol XL) known for having less risk of myopathy?
The long acting or slow release of the drug provides lower serum levels and is less likely to enter into muscle cells to casue myopathy. It is very expensive.
Which formulation of nifedipine is recommended?
The long acting or sustained-release
Trough Level
The lowest concentration reached by a drug before the next dose is administered
Placental Drug Transfer
The membranes of the placenta separate the maternal circulation from the fetal circulation. However, the membranes of the placenta do NOT constitute an absolute barrier to the passage of drugs.
When an inducing drug such as phenobarbital is taken concurrently with another medication, the metabolism of the other medications is (increased or decreased)?
The metabolism is increased and the drug is excreted more rapidly.
Define aura.
The migraine headache is preceded by neurologic symptoms such as flashes of light, a blank area in the field of vision, or a zig-zag pattern. Only 30% of "migraineurs" have auras.
Minimum Effective Concentration (MEC)
The minimum effective concentration (MEC) is defined as the plasma drug level below which therapeutic effects will not occur. To be of benefit, a drug must be present in concentrations at or above the MEC.
Absorption
The movement of a drug from its site of administration into the blood.
Excretion
The movement of drugs and their metabolites out of the body.
Define pharmacodynamics
The nature and intensity of the response that the drug has on the body.
What does an increased RDW signify?
The new RBCs are larger or smaller than the old RBCs
Which member of the health care team is most likely to observe and evaluate drug responses and intervene if required?
The nurse.
Why is Salmeterol (Serevent) never used as a "rescue" medication?
The onset of action with salmeterol is delayed and takes 10-30 min to start working. Because of this, salmeterol should never be used as a rescue medication.
What is the primary use of fibric acid derivatves (fibrates) such as gemfibrozil (Lopid) and fenofibrate (Tricor)?
The principal indication of fibrates is to reduce triglycerides levels
Formulation
The process in which different chemical substances are combined to produce a final medicinal product.
Reconstitution
The process of adding a diluent to a dry ingredient to make it a liquid.
Induction
The process of stimulating enzyme synthesis. Drugs that act on the liver to increase rates of drug metabolism are inducers. As the rate of drug metabolism increases, plasma drug levels fall.
What type of research is required to assess drug therapies?
The randomized controlled trial is required for all new medications.
First-pass Effect
The rapid hepatic inactivation of certain oral drugs.
What adverse effects would you warn patients about before stating statins?
The risk of myopathy and hepatotoxicity (which is rare).
Affinity
The strength of the attraction between a drug and its receptor.
Pharmacokinetics
The study of drug movement throughout the body.
Pharmacogenetics
The study of how genetic variations can affect individual responses to drugs.
A patient with Alzheimer's disease is taking rivastigmine (Exelon). The patient develops an allergic reaction and is treated with diphenhydramine (Benadryl). What occurs when cholinesterase inhibitors are combined with anticholinergic agents?
The therapeutic effect of the cholinesterase inhibitor is reduced
It is defined as the ratio of a drug's LD50 (which is average lethal dose in 50% on animals tested) to its ED50 (therapeutic dose in 50% of a population), what is this known as?
The therapeutic index (the measure of drug safety).
The range of plasma drug level that falls between minimum effective concentration (MEC) and the toxic concentration is called what?
The therapeutic range.
Half-life
The time for the amount of drug in the body to decrease by 50%
Half-Life (T 1/2)
The time required for the amount of drug in the body to decrease by 50%
Blood-brain barrier
The unique anatomy of capillaries in the CNS.
What older agent used to treat asthma has been mostly replaced because it has a narrow therapeutic range as well as many drug-drug reactions?
Theophylline
State another advantage of PCA.
Therapeutic levels stay within the therapeutic range.
Why do patients with PD have more than just movement disorders?
There are dopamine receptors throughout the body and when there is a decline in dopamine, additional manifestations occur.
Why should patients who have used their Epi Pen be hospitalized for up to 6 hours?
There can be a biphasic and prolonged phase to an anaphylactic reaction
Why was the maximum dose of citalopram lowered to 20 mg
There is a risk of QT prolongation with higher doses
What is the potential problem with the concurrent use of SSRIs and NSAIDs?
There is an increased risk of bleeding with this combination.
Why is sacubitril combined with and an ARB rather than an ACEI?
There is less risk of hyperkalemia, cough, less bradykinin buildup and angioedema with ARBs
How are natriuretic peptides helpful to the body?
These are natural substances that work a little bit like diuretics to rid the body of excess sodium
Why is it important to take triptans at the first onset of the migraine?
These drugs are more effective when used in the early stage of a migraine.
Why is it important to check a CMP after initiation of an ACEI or ARB?
These drugs can in rare situations cause acute renal failure
Brain natriuretic peptide (BNP) and is produced in the ventricles of the heart and is stimulated in response to fluid overload. What is the impact of these naturally occurring peptides?
These peptides reduce blood volume and promote dilation of arterioles and veins to lower arterial blood pressure. BNP levels are measured in the serum and serve as a marker for heart failure.
What happens when barbiturates stimulate synthesis of hepatic microsomal enzymes?
They accelerate their metabolism and that of many other drugs.
Are long acting inhaled beta-2 agonist ever used as monotherapy?
They are approved as monotherapy only in patients with COPD, not for Asthma.
What is the MOA of conventional antipsychotic drugs?
They block receptors for dopamine
What is the relationship between potassium and digoxin?
They both compete for entry into the cell. If potassium is low, more digoxin gets in. If the potassium is high, the digoxin is less effective.
Why should anticholinergic agents be avoided when using low potency antipsychotics such as chlorpromazine (Thorazine)?
They both have anticholinergic effects
Conventional antipsychotic drugs have anticholinergic, neuroendocrine and sexual side effects. What can they do to BP and mental state?
They can lower BP and cause sedation.
Why are antiarrhythmics avoided in patient with HF?
They may worsen HF and increase sudden death
Why are sympathomimetics and MAOIs incompatible?
They promote the release of norepinephrine and can contribute to HTN crisis.
Why are ACE inhibitors considered first line treatment of hypertension for patients with diabetes?
They reduce glomerular filtration pressure and slow development of renal injury.
Why are AEDs helpful for chronic neuropathic pain?
They reduce synaptic transmission and potentiate GABA
Why are glucocorticoids used to treat asthma?
They suppress inflammation.
Why are NOACs not used in patients with artificial heart valves?
They were not found to be effective at reducing thromboembolism
State the drugs that are chemically related to sulfonamides that should not be given if sulfa sensitivity exists?
Thiazide & loop diuretics, sulfonylureas, and celecoxib (Celebrex)
the most effective antihypertensive agents for African Americans
Thiazide diuretics and CCBs. BB and ACE are no better than placebo. ARBs, CCBs, were more effective than placebo.
Patients with sensitivity to sulfonomides (sulfa allergy) may have problems with which type of diuretics
Thiazide diuretics such as HCTZ and chlorthalidone
Why would a thiazide diuretic be helpful for a woman with HTN and osteoporosis?
Thiazides promote tubular reabsorption of calcium to decrease the risk of osteoporosis in postmenopausal woman
Patients receiving nitroprusside for more than 3 days should undergo monitoring of plasma _______, which must be kept below 0.1 mg/ml
Thiocyanate
Prolonged use of nitroprusside can lead to what type of toxicity?
Thiocyanate toxicity. S/S include disorientation, psychotic behavior, delirium.
Which generations of cephalosporins are highly resistant to beta-lactamase enzymes that cleave the beta-lactam ring of cephalosporins rendering them inactive?
Third and 4th generation cephalosporins
Which generations of cephalosporins are more active against gram-negative aerobes?
Third and fourth generation (4th has the highest activity)
What is reflex tachycardia?
This can occur when drugs are given that dilate arterioles
A patient is taking an antiepileptic drug such as phenytoin. Some seizure medications stimulate the liver to make more drug-metabolizing enzymes that speeds up the breakdown of the drug. Chose the correct statements in reference to this consideration in drug metabolism. (Choose all that apply).
This is an example of induction of drug metabolizing enzymes. A drug given with an inducing agent may need to have an increased dosage.
Who should receive supplemental iron?
Those with anemia or those at risk (pregnancy-infancy)
In what situations would you still want to use an ACEI or ARB in African Americans?
Those with diabetes, kidney disease or MI
Statins should be discontinued if liver transaminases are elevated greater than _____ time the upper normal limits.
Three
tPA (Alteplase, Activase)
Thrombolytics
What are the drugs called that promote the conversion of plasminogen to plasmin (an enzyme that digests the fibrin matrix of clots)?
Thrombolytics such as Alteplase (tPA).
Liraglutide (Saxenda) should not be used in patients with a history of_________?
Thyroid cancer or pancreatitis
What are the signs of ototoxicity?
Tinnitus can be a sign of cochlear damage and vestibular damage
Long-acting muscarinic antagonists LAMA
Tiotropium
Which two muscle relaxants can cause liver damage?
Tizanidine (Zanaflex) and metaxalone (Skelaxin)
Why are WBCs measured weekly on patients receiving filgrastim (Neupogen)?
To avoid drug induced leukocytosis
Why are combinations of antiretroviral drugs recommended?
To avoid resistance
All patients with PUD and confirmed infection with H. pylori should be treated with antibiotics in combination with an antisecretory agent. What is the reason for using 2 antibiotics?
To avoid resistance and increase efficacy
What is the goal of pharmacologic therapy in treating Parkinson's disease?
To balance cholonergic and dopaminergic activity in the brain
What is the purpose of using a spacer?
To increase delivery of drug to the lungs & decrease deposition on the tongue.
Why would a combination nasal corticosteroid spray and antihistamine spray be used for allergic rhinitis?
To increase efficacy. A new combination nasal corticosteroid spray and antihistamine spray is called Dynamist
Why are depressed patients given no more than a 1 week supply of TCAs at a time?
To minimize the risk of death by suicide.
Why are multiple drugs used to treat TB
To prevent drug resistance
Why are opioids given on a fixed schedule?
To prevent pain before it returns, sparing the patient needless discomfort.
Why are patients with congenital valvular disease and those with prosthetic heart valves prescribed prophylactic antimicrobial medication prior to surgery and dental procedures which can interrupt the oral mucosa causing migration of oral flora?
To prevent sub acute bacterial endocarditis (SBE)
What are the indications for angiotensin receptor-neprilysin inhibitor (ARNI) valsartan/sacubitril (Entresto)
To reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction
What are some of the common triggers of asthma?
Tobacco smoke, wood smoke, household sprays, viruses, and other allergens. Allergens and environmental factors, upper respiratory infections (URI), and psychological factors such as stress
Why is tobacco such a problem in respect to ASCVD?
Tobacco use inflames the vasculature and accelerates the process of atherosclerosis
Transdermal
Topical agents (e.g., nitroglycerin, nicotine, testosterone, estrogen) are formulated for transdermal absorption into the systemic circulation.
What is the name of the antiepileptic drug that promotes but is not yet approved for weight loss?
Topiramate (Topamax)
Which antiepileptic drugs can cause metabolic acidosis?
Topiramate and zonisamide
Which AED can be used for migraine prophylaxis and often leads to weight loss?
Topiramate. Most other AEDs cause weight gain.
How are beta blockers prescribed?
Toprol or the generic form metoprolol succinate can be dosed daily. Metoprolol tartrate is on the $4 and needs to be dosed BID
Which drug class has a longer duration of action and better absorption?
Torsemide
Which loop diuretic has a longer duration of action and better absorption?
Torsemide
To lower cholesterol, dietary fat should be lowered to what % of total caloric intake?
Total fat limited to 25%-35% of total calories.
What occurs when diuretics are used with lithium?
Toxicity can occur due to sodium loss.
What is the purpose of having a trade name (proprietary or brand name) for a drug?
Trade names are easy to recall and pronounce, and good for marketing purposes.
Phenytoin
Traditional AED
What are examples of other drugs that are not used for depression that are considered "serotonergic"?
Tramadol, linezolid, triptans, meperidine, and dextromephorthan
A pregnant woman with hypertension requires drug therapy for HTN. Which agent should not be prescribed?
Trandolapril
List the causes of hyperkalemia.
Trauma, renal failure, acute acidosis, ACE inhibitors, ARBs, aldosterone blockers, and Addison's disease
List the causes of hyperkalemia
Trauma, renal failure, acute acidosis, ACE inhibitors, Addison's
Which atypical antidepressant can cause priapism and prolongation of the QT interval?
Trazadone
Which atypical antidepressant is sedating and has been known to cause priapism?
Trazadone
Which of the following atypical antidepressants can cause sedation, QT prolongation, and priapism?
Trazadone
Rules for sleep fitness also called "sleep hygiene" can be more helpful than pharmacotherapy without the side effects. What other drugs are used to promote sleep?
Trazodone (atypical antidepressant), doxepin (older TCA), diphenhydramine, and melatonin.
What are the uses for dopamine?
Treatment of shock and to increase renal perfusion.
Lovaza is the trade name for the first prescription preparation of omega-3-fatty acids. What at the indications?
Treatment of triglycerides >500 mg/dL
Which clinical manifestations are common side effects of albuterol?
Tremors Palpitations
A blood-tinged, purulent, foul smelling and itching discharge is likely _______?
Trichomoniasis
Which of the following drug classes have anticholinergic properties (choose all that apply)?
Tricyclic antidepressants Antihistamines Antipsychotics
Name other classes of drugs that have anticholinergic properties and could be problematic for patients treated with cholinesterase inhibitors.
Tricyclic antidepressants, antipsychotics, and antihistamines
The following: stress, fatigue, anxiety, alcohol, and tyramine rich foods are considered to be common migraine____________________?
Triggers. Migraineurs benefit from regular sleep habits, stress reduction, exercise, and healthy regular meals otherwise called "self-care."
What is the preferred treatment for prophylaxis and treatment of Pneumocystis (PCP)?
Trimethoprim plus sulfamethoxazole
Which of the following antibiotics would be problematic during pregnancy especially in the third trimester?
Trimethoprim/sulfamethoxazole Levofloxacin Nitrofurantoin Doxycycline
Can triptans be used in pregnancy?
Triptans should be avoided during pregnancy
True statements regarding "triptans"
Triptans suppress inflammatory neuropeptides Triptans can cause symptomatic coronary vasopspasm and should not be used in individuals with heart disease Chest symptons described as "heavy arms" and "chest pressure" can occur and are NOT related to ischemic heart disease
An overwhelming feeling of chest tightness and a heavy sensation in the chest is a common side effect of which agents that are used to treat migraine headaches?
Triptans. The chest tightness is not related to ischemia and is transient.
Atenolol has been shown to be less effective than other beta blockers (true or false)
True
Classification of blood pressure was used in the previous JNC-7 guidelines. This staging is no longer used in the most current 2014 guidelines (true or false)
True
Creatinine levels do not reflect kidney function in the elderly because the source of creatinine is lean muscle which declines in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced. True or false?
True
Drugs that dilate veins intensify and prolong postural hypotension. True or False?
True
Recent large studies comparing first generation antipsychotics and second generation antipsychotics showed that they are equally effective and side effect profiles were also equally detrimental. True or false?
True
True or False: All antipsychotics can cause weight gain.
True
True or False? Triptans cause vasoconstriction and a decrease in perivascular inflammation
True
True or False: All SSRI's can cause insomnia.
True, with the exception of paroxetine which can be sedating.
Patients with diabetes most often succumb to cardiovascular disease (true or false)?
True. This is why diabetes is often considered a "risk equivalent" to ASCVD
What does it feel like to have asthma?
Try breathing through a straw or take a deep breath and without inhaling a full amount try to take another breath. This is the inability to "get the air out" due to obstruction
What time of day is the greatest risk for ischemia?
Two hours after awakening
For a diagnosis of depression to be made, symptoms such as loss of pleasure, insomnia, anorexia, feelings of guilt, and worthlessness must be present most of the day, nearly every day, for at least__________weeks?
Two weeks
Why are foods high in tyramine avoided when patients are taking MAOIs?
Tyramine is not broken down when MAO is inhibited and leads to HTN.
Avocado, soybeans, figs, fermented meats, cured fish, cheeses, yeast extract, imported beer, Chianti wine, protein dietary supplements are all examples of foods high in_____________?
Tyramine.
When would a short course of antibiotics (3 days) be appropriate for a UTI?
Uncomplicated cystitis and no previous treatment with an antibiotic
Is there evidence that consuming fatty fish or consuming fish oil supplements can reduce the risk of ASCVD?
Unfortunately no, however, the American Heart Association (AHA) still recommends consumption of 2 serving/week
What warning is now given to patients taking agents similar to zolpidem (Ambien)?
Unusual activity such as driving, sleep walking, and eating.
How long would the impact of grapefruit juice be expected to last?
Up to 3 days.
Proper hygiene, increasing fluids, voiding after intercourse and a single dose prophylaxis of TMP/SMZ 160 mg/800 mg taken after intercourse can prevent______________?
Urinary tract infections
What are the major uses for sulfonamides?
Urinary tract infections (UTI)
Bethanechol (Urecholine) activates muscarinic receptors and leads to (urination or urinary retention)?
Urination
Define microalbuminuria:
Urine albumin to creatinine ratio > 30mg/mL
Why do patients with diabetes need to be concerned if they are being treated with diuretics?
Use of high doses of diuretics can elevate blood sugar levels
What is the proper technique for measuring BP?
Use the correct size cuff. No ETOH or tobacco for 30-60 minutes prior to reading. Inflate cuff 30 mm of Hg higher than the brachial artery palpation, arm supported level of the heart, slowly deflate 2-3 mm Hg per heart beat
Should beta blockers be used in patients with peripheral vascular disease or depression?
Use with caution because beta blockers can worsen these conditions.
What is one of the problems with trade names?
Using 2 brand named drugs that have the same ingredient can lead to overdose.
Why are ACE inhibitors and potassium sparing diuretics such as as spironolactone used together with caution?
Using both can lead to hyperkalemia.
Fluconazole (Diflucan) 150 mg po x1 or itraconazole (Sporanox) 200mg po bid x1 are indicated in the treatment of ________?
Vaginal candidiasis
Visceral pain results from injury to organs and is described as______________?
Vague, difuse and aching
Dietary supplements are commonly used for anxiety and insomnia. Which of the following supplements can cause CNS depression and should not be used with alcohol or other sedating drugs:
Valerian Kava
Which of the AEDs is known to cause neural tube defects and other congenital malformations as well as fatal liver injury?
Valproic acid
What is the drug of choice for bipolar disorder?
Valproic acid has replaced lithium as a drug choice for many patients.
Which ARBs have evidence based trials that show benefit in HF?
Valsartan and candesartan
What drug is used only for serious infections such as antibiotic associated pseudomembranous colitis (AAPMC) and resistant bacteria such as MRSA?
Vancomycin
Which antibiotic has serious side effects such as ototoxicity, phlebitis, rash, pruritus, urticaria, tachycardia, and hypotension (collectively known as "Red Man's Syndrome)?
Vancomycin
What are effective alternatives to PCNs for patients with a PCN allergy?
Vancomycin, clindamycin, erythromycin (macrolides), & fluoroquinolones.
PDE5 inhibitors are used in men with cardiovascular risk factors. Which agent should not be prescribed to men taking antidysrythmic drugs?
Vardenafil (Levitra)
What can occur if an alpha1 agonist that is given IV is given into SQ tissue such as with an infiltrated IV?
Vasoconstriction can lead to tissue necrosis (extravasation)
How does nitroglycerin decrease the pain of exertional angina?
Vasodilation reduces preload which in turn decreases oxygen demand
Why is morphine given to patients with MI?
Vasodilation that decrease myocardial oxygen demand and pain relief
Do vasodilators that dilate resistance vessels (arterioles) increase or decrease after load?
Vasodilators decrease afterload.
Heparin and warfarin prevent thrombosis in arteries or veins?
Veins
Nitrates site of vasodilation
Veins
A patient that has hypertension will have an increase in blood pressure with the use of______?
Venlafaxine
Name the NSRI that can cause hypertension and has an intense withdrawal syndrome that includes anxiety, agitation, tremors, headache, vertigo, nausea, tachycardia, and tinnitus.
Venlafaxine (Effexor)
What are the most severe complications of an MI?
Ventricular dysrhythmias, cardiogenic shock, heart failure, & cardiac rupture.
What are the approved indications for the use of amiodarone?
Ventricular dysrhythmias. It is used off label for AF
Which of the following CCBs are classified as Class IV antidysrhythmic agents and have an effect on the heart rate by blocking the SA and AV node:
Verapamil Diltiazem
A patient presents with a heart rate of 40 BPM. Which of the following drugs contribute to the slow rate:
Verapamil Metoprolol Digoxin
Which of the following drugs can decrease heart rate:
Verapamil Propranolol Digoxin Diltiazem
Which two CCBs act on the vascular smooth muscle and the heart?
Verapamil and diltiazem.
Can digoxin and verapamil be used together?
Verapamil can increase digoxin levels by 60% leading to digoxin toxicity.
Constipation, edema of the ankles and feet, dizziness, facial flushing, AV block, bradycardia, and cardiosuppression are all side effects of _______?
Verapamil.
Which of the CCBs is known to cause infertility in men?
Verapamil. Sperm are not functional when calcium channels are blocked.
What happens if metronidazole (Flagyl) and alcohol are taken together?
Violent nausea similar to a disulfiram-like reaction occurs
Giving folic acid for macrocytic anemia will correct the anemia but may mask ________deficiency?
Vitamin B12 deficiency
How are patients with pernicious anemia treated?
Vitamin B12 is administered parenterally
A patient on warfarin has an INR of 6. The nurse prepares:
Vitamin K
Reverses warfarin-induced inhibition of clotting factor synthesis and can be given orally or IV
Vitamin K
Which vitamin is required for the synthesis of four clotting factors (VII, IX, X and prothrombin)?
Vitamin K
Warfarin
Vitamin K Antagonist
What is the treatment for warfarin overdose?
Vitamin K, FFP, or concentrate of vitamin K dependent clotting factors.
Which anticoagulant is used long term to prevent thrombosis in pateints with prosthetic heart valves, or patients with atrial fibrillation?
Warfarin
Which anticoagulant suppresses coagulation by acting as an antagonist of vitamin K?
Warfarin
What drug is given to reduce the risk of recurrent MI and TIA and is used to prevent thrombosis in patients with atrial fibrillation?
Warfarin (Coumadin).
Why is warfarin an inappropriate anticoagulant for emergency use?
Warfarin has a delayed onset of action.
Give an example of a drug that is highly bound to protein
Warfarin is 99% bound to protein, ASA and fluoxetine (Prozac) are others.
Give examples of drugs that have genetic testing recommended
Warfarin, carbamazepine, trastuzumab, abacavir
Bactrim can intensify the levels of which drugs?
Warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics
What would you recommend to an individual to assist the effect of guaifenesin?
Water intake needs to be sufficient for best results
What recommendations are provided to signal fluid retention in patients with HF?
Weigh daily. Gain > 3-5 lbs. over a period of 24 hours indicates fluid retention
Second generation antipsychotics cause metabolic effects such as:
Weight gain Diabetes Dyslipidemia
What is the most effective nonpharmacologic lifestyle modification to lower blood pressure?
Weight loss
What are some of the SE of roflumilast (Daliresp)?
Weight loss and psychiatric events. It should not be used in pregnant women
Drugs for ADHD can cause:
Weight loss, concern for growth, and insomnia
How is anemia classified?
Weintraub's classification
Pharmacokinetics
What the body does to the drug
Pharmacodynamics
What the drug does to the body
How is the first pass effect is circumvented?
When a drug is given parenterally (IV, IM, SL, or SQ).
Describe Starling's law of the heart.
When more blood enters the heart, more blood is pumped out in a healthy heart
When is clozapine used?
When patients do not respond to other drug treatments.
When is clozapine contraindicated?
When taking drugs that suppress bone marrow function causing agranulocytosis.
When would it be a priority to treat elevated triglycerides?
When the TG lv is >500 mg/dL
Children's dosages are calculated as mg/kg/day. Sometimes the mg/kg/day are more than the adult dose. When would a child be given an adult dose rather than the mg/kg/day?
When the child is approximately 40-50 kg or 88-110 lbs, the adult dose is prescribed.
Desensitization
When the receptors of a cell are continually exposed to an agonist, the cell usually becomes less responsive.
What is the treatment of NMS?
Withdrawal of offending agent, cooling, hydration, BZDs, dantroline, & bromocriptine
Explain what happens when a partial opioid agonist (agonist-antagonist) such as pentazocine (Talwin) is given to an individual that is dependent on morphine.
Withdrawl symptoms can occur when the mu receptors are blocked
Why are women at more at risk for QT interval prolongation?
Women have longer QT intervals than men.
Which of the following statements are true regarding kidney function in the older adult? (Choose all that apply)
Women have reduced creatinine levels Older adults have less creatinine because they have less muscle
Phentermine/topiramate (Qsymia) is Pregnancy Category_______?
X (these categories are no longer used)
Which BZD has an increased potential for developing dependence?
Xanax (alprazolam)
How often is an EKG needed in a patient on ADHD drugs?
Yearly EKG is done yearly to check for dysrhythmias and prolonged QT interval
A patient started on an antipsychotic complains of sexual dysfunction. Can this be attributed to the medication?
Yes
Can SSRIs reduce the effectiveness of tamoxifen?
Yes
Can children grow out of asthma?
Yes
Can fibric acid derivative (fibrates) cause muscle or liver injury?
Yes
Can grapefruit and grapefruit juice increase statin levels?
Yes
Can muscle relaxants cause physical dependence?
Yes
Can the baroreceptor response temporarily negate the effect of drugs used to lower blood pressure?
Yes
Can the use of ergotamine cause physical dependence?
Yes
Can toxicity be increased when ezetimibe is combined with a statin?
Yes
Can you initiate an ACE or ARB in a patient with an elevated creatinine?
Yes
Do alpha blockers differ in their specificity of receptor blockade and resultant impact on blood pressure?
Yes
Do pharmacokinetics change throughout the lifespan?
Yes
Do you need to taper discontinuation of muscle relaxants to avoid an abstinence syndrome?
Yes
Does clonidine slow the heart rate?
Yes
Does cross tolerance occur with opioid drugs?
Yes
Does niacin cause adverse effects in nearly all patients?
Yes
Is phenytoin active against dysrhythmias?
Yes
Is the Patient Health Questionnaire (PHQ-9) validated in the elderly?
Yes
Do alpha-adrenergic antagonist (alpha 1) differ in their specificity of receptor blockade and resultant impact on blood pressure?
Yes (older agents are approved for HTN)
Can SSRIs cause extrapyramidal side effects?
Yes but it is rare.
Are LABAs ever used as monotherapy?
Yes in patients with COPD
Is carisoprodol (Soma) a controlled substance?
Yes it requires a DEA number and is Schedule IV. To find this information, scroll in ePocrates to "Manufacturing/Pricing" to see the DEA/FDA information. Other muscle relaxants in this class are not controlled (cyclobenzaprine and metaxalone).
Can antibiotics cause QT prolongation?
Yes, FQs and macrolides have warnings for QT prolongations
Do bile acid sequestrants cause constipation?
Yes, along with other GI effects?
Is there a problem with the combination of ACEIs and lithium?
Yes, concurrent use can cause lithium levels to rise to toxic levels.
Can heparin be used in pregnancy?
Yes, heparin is the preferred anticoagulant drug during pregnancy.
Can diuretics effect lipid levels?
Yes, high doses of diuretics can elevate LDL and lower HDL
Can you get angioedema and hyperkalemia with an ARB?
Yes, however it is less frequent
Are beta blockers approved for the treatment of heart failure?
Yes, however they need to be titrated slowly
Are ARBs considered "first line" agents for the treatment of HTN?
Yes, however, it is recommended to start with an ACEI due to cost and use an ARB if the patient develops a cough
Does bupropion have an interaction with tamoxifen?
Yes, it can reduce the effectiveness of the tamoxifen
Pregabalin (Lyrica) is approved for DPN at a cost of about $600/month. Is it a controlled substance?
Yes, it is Schedule V in Florida. State Boards of Pharmacy make this determination.
Do ACEIs and lithium have an interaction?
Yes, lithium levels can be elevated when ACEIs are used
Do liver transaminase levels need to be monitored during treatment with nicotinic acid (niacin)?
Yes, nicotinic acid can be hepatotoxic.
Are ARBs approved for heart failure?
Yes, valsartan and candesartan are approved for heart failure
Can SSRIs cause bruxism?
Yes-get a mouth guard!
The Direct Thrombin Inhibitor dabigatran (Pradaxa) has a rapid onset, short half-life, does not require monitoring, has less drug interactions than warfarin, and less risk of bleeding. Is there a reversal agent?
Yes. It is called idarucizumab (Praxbind) new to the market in 2016
Can BZDs lead to physical dependence?
Yes. Patients receiving chronic high doses of BZDs should be weaned gradually.
Will statins lower triglycerides?
Yes. Treat with statins and add other agents if needed as long as the TG are less than 500 mg/dL. The priority is to treat LDL-C as this is proven to have the greatest benefit.
Using Lovaza can lower triglycerides by about ______%
about 20-50%
How does lidocaine (class IB-accelerate repolarization) effect repolarization?
accelerates repolarization (shortens action potential duration and the ERP)
What is the second best intervention that can lower BP by 8-14%
adhereing to the Dash Diet
The arterial pressure that the left ventricle must overcome to eject blood
afterload
Which of the following can occur with the use of the NRTI zidovudine
anemia lactic acidosis Correct! hepatomegaly
The inability to experience pleasure from activities usually found enjoyable
anhedonia.
How do BB (class II-antidysrhythmics) effect automaticity of the SA node?
decrease automaticity of the SA node
How do BB (class II-antidysrhythmics) effect myocardial contractility?
decrease myocardial contractility
How do BB (class II-antidysrhythmics) effect conduction through the AV node?
decrease the velocity of conduction through the AV node
Hydralazine
direct acting vasodilator
Why is is important to check renal function after initiating an ACE inhibitor?
eGFR can decrease in the presence of renal artery stenosis.-If > 30% -D/C the drug
Guaifenesin is an expectorant that makes secretions (easier or more difficult) to expel?
easier
What are other causes of increased creatinine kinase (CK levels) other than the use of statins?
exercise
Which of the following drugs are considered inappropriate for older adults (select all that apply)
hydroxazine quetiapine alprazolam tolterodine clonidine
Oral sympathomimetics like pseudoephedrine (Sudafed) cause vasoconstriction and should not be used in patients with_________________________?
hypertension or coronary artery disease
A disease or condition produced by a doctor or other health care provider or drugs is known as what?
iatrogenic.
When venous return increases, does cardiac output increase of decrease?
increase
these increase cardiac workload and should not be given to pts with MI
increase
What drug is used sometimes by pulmonologists to provoke bronchoconstriction that can help diagnosis asthma?
methacholine
Some individuals may not fall into any of the 4 high risk groups but may still need to be treated. Other factors to consider in making the decision are:
patient preference; LDL-C greater than or equal to 160 mg/dL or other evidence of genetic hyperlipidemias; family history of premature ASCVD with onset < 55 years of age in a first degree male relative or < 65 years of age in a first degree female r
The amount of tension (stretch) applied to the muscle prior to contraction. Stretch is determined by the force of venous return and is measured as end diastolic volume
preload in the heart
How do BB (class II-antidysrhythmics) effect length of PR interval on EKG?
prolonged PR interval
How does lidocaine (class IB-accelerate repolarization) effect automaticity?
reduces automaticity in the ventricles and His Purkinje fibers by blocking sodium channels in the heart
BP that is not controlled despite a combination of TLC and the use of full therapeutic doses of 3 medications (one of which is a diuretic)
resistant or refractory HTN.
Diabetes is considered a " __________ equivalent" because it poses the same 10 year risk of a coronary or cerebral event as patients with existing ASCVD.
risk
How does lidocaine (class IB-accelerate repolarization) effect conduction?
slows conduction in the atria, ventricles, and His-Purkinje fibers by blocking sodium channels in the heart
Can antibiotics interfere with oral contraceptives?
yes
Is tramadol a scheduled drug?
yes
