NURS 615 Exam II Questions and Answers

Document Content and Description Below

What blood values should be monitored with carbamazepine? - ANSWER Plasma carbamazepine levels should be monitored on a regular basis. The therapeutic range is 4 to 12 mcg/L. Higher levels can lead to... toxic symptoms consisting of initial adverse effects and also hypertension, tachycardia, ECG changes, stupor, agitation, nystagmus, urinary retention, respiratory depression, seizures, and coma. Children and elderly patient may develop toxicity levels below 12. CBC every 3 to 4 months Affects RBC, WBC, Platelets Agranulocytosis, Anemia What is the pharmacodynamics of carbamazepine? - ANSWER Carbamazepine is metabolized in the liver and has the unique ability to induce its own metabolism (autoinduction). Due to autoinduction, initial concentrations within therapeutic range may later fall despite good compliance. It also induces the metabolism of many CYP450 enzymes and other substances. Slowly but well absorbed half life of about 30 hours, shortens to 15 hours when given repeatedly The exact mechanism of action of carbamazepine is not known, but they are thought to affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing the spread of abnormal activity. Carbamazepine exerts its effect by depressing transmission in the nucleus ventralis anterior of the thalamus. This area is associated with the spread of seizure discharge. •Absorption and Distribution Carbamazepine is absorbed through the stomach, the suspension being absorbed more quickly than the tablet form. Absorption from the immediate-release tablets is slow and erratic because of its slow water solubility. The drug is highly lipophilic, resulting in high body tissue binding. •Metabolism and Excretion Excretion is through feces and urine. Average blood levels of carbamazepine occur approximately 6 hours after administration. Half-life can be as long as 65 hours with initial dosing, but is typically 12 to 17 hours as administration continues. It is noteworthy that the half-life after a single dose is much longer than the half-life after long-term use. Steady state is attained in 2 to 4 days. What should families be taught regarding the monitoring of seizure activity? - ANSWER Patients should be monitored for seizure activity, severity, and duration. Patient should carry medical identification for the seizure disorder. Patient should report any mood changes or suicidal thoughts. Prevention of seizures. Do not abruptly end medication increases risk of seizures What electrolyte imbalance is noted with the administration of topiramate? - ANSWER Patients taking topiramate may have decreased concentrations of bicarbonate due to inhibition of carbonic anhydrase and increased renal bicarbonate loss, leading to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been reported in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels should be monitored at baseline and periodically throughout therapy. What is the pregnancy category for valproate? - ANSWER Pregnancy Category X. What instructions will you provide to a woman who wants to get pregnant and has a seizure disorder controlled with valproate? - ANSWER Switch to another antiseizure medication such as Keppra Use of these drugs during the first trimester of pregnancy is associated with neural tube defects including spina bifida. Their use should be restricted to cases in which a woman's life would be endangered without them and then only beyond the first trimester. They should be used with caution during lactation. What are the precautions and contraindications for the tricyclic antidepressants? - ANSWER •Most significant risks are cardiac conduction disorder. At highest risk are children and the elderly therefore, baseline ECG and periodic monitoring should be performed. The most common cardiovascular effect is sinus tachycardia due to the inhibition of norepinephrine reuptake and anticholinergic action. Contribute to the slowing of depolarization of the cardiac muscle, contributing to prolongation of the QRS complex and the PR/QT intervals. Can be cardiotoxic in overdose. •TCAs have a direct alpha-adrenergic blocking effect and quindine-like effect on the myocardium, they are contraindicated for those with cardiovascular disorders. •Due to their acetycholine blocking effect they should be used with caution in those who have glaucoma, prostatic hypertrophy, or urinary incontinence. •Should not be prescribed in combination with MAOIs or individuals who have demonstrated hypersensitivity in this class. •Pregnancy category C and are excreted in low doses in breast milk. Safety of use in pregnancy is unclear. •Tardive dyskinesia and neuroleptic malignant syndrome have been reported, and more likely with amoxapine use due to its dopaminergic effect. •Should be titrated gradually in either direction. Nausea, headache, vertigo, malaise, and nightmares have been noted following abrupt discontinuance of the drug or after large dose decreases. •Lower seizure thresholds in those with seizure disorder or those taking medications that also decrease seizure threshold. •Therapeutic and toxic level index is LOW. Great care needs to be taken when prescribing for a person who is depressed and has suicidal ideas. •APRNs need to be alert for an energizing effect that precedes depressive symptom remission because this may contribute to sufficient activation to follow through with a suicidal plan. Patients need to be monitored on a weekly basis, especially regarding suicidal thoughts and behaviors, and medication should be dispensed in only small amounts until suicidal risk decreases. •Used in extreme caution in the elderly due to their anticholinergic and norepinephrine effects they contribute to confusion, orthostatic hypotension, and falls. Phenelzine (Nardil) is an MAO inhibitor. What are the cautions and contraindications? How is it used to treat recalcitrant depression? - ANSWER •Contraindications Liver or kidney disease Hypersensitivity Congestive heart failure or arteriosclerotic disease Age over 60 years Pregnancy category C; excreted in breastmilk safety not established Not approved for use with children Postural hypotension and suppression of myocardial pain may occur. •MAOIs exert their effect by irreversibly inactivating the enzymes that metabolize norepinephrine, serotonin, and dopamine, thereby increasing the bioavailability of these neurotransmitters. FUll 2 weeks to clear from system should wait that long to start a different therapy What are the symptoms of hypertensive crisis? - ANSWER •MAOIs inhibit the metabolism of norepinephrine and can cause hypertensive crisis. Foods high in tyramine should be restricted because of this risk as well as they are the precursor to dopamine, norepinephrine, and epinephrine. •Treatment of hypertensive crisis needs to be managed immediately, and the patient should remain standing until it is. Usual treatment is phentolamine (Regitine) 5mg IV and then 0.25mg to 0.5mg IM every 4 to 6 hours. •Hypertensive crisis symptoms include: Headache Heart palpitations Stiff/sore neck Chest tightness Tachycardia Sweating Dilated pupils How long does it take for selective serotonin reuptake inhibitors to produce an effect in patients with depression? - ANSWER These drugs may take as long as 2 to 6weeks until their full therapeutic benefits become evident and the initial adverse reactions, commonly, nausea, intermittent light-headedness, sedation, muscle restlessness, and sleep disruptions, should be minor and transient. When are buspirone (Buspar) and an SSRI combined? - ANSWER Although buspirone can used as the sole pharmacotherapeutic modality for anxiety, it is frequently used adjunctively with SSRIs in treatment-resistant depression because of the combined serotonergic mechanisms, that is, postsynaptic reuptake inhibition and receptor agonism. What type of diet is recommended with the administration of lithium? - ANSWER Patients should ensure adequate salt intake when taking lithium. What factors will place the patient at risk for antibiotic resistance? - ANSWER The leading risk factors for having a drug resistant pathogen include recent use of antibiotics, age younger than 2 years old or older than 65 years old, day-care center attendance, exposure to young children, multiple medical comorbidities, recent hospitalization, and immunosuppression. What factors place the patient at risk for hypersensitivity reactions with penicillins and cephalosporins? - ANSWER A history of serious hypersensitivity reaction (e.g., anaphylaxis, serum sickness, exfoliative dermatitis, hemolysis, or other blood dyscrasia) to a penicillin contraindicates the use of any penicillin on account of cross sensitivity. Severe, type I allergic reactions to cephalosporins, carbapenems, or beta-lactamase inhibitors may contraindicate use of penicillins. Patient with a history of allergy to other substances (e.g., atopic skin conditions) should also use these drug with caution. What are the safest antibiotics to prescribe to a woman who is pregnant? - ANSWER Isoniazids are pregnancy category A antibiotics and are safest prescribe in pregnancy. Which antibiotics inhibit bacterial cell wall synthesis? - ANSWER Beta-lactams; penicillins, cephalosporins, carbapenems, and monobactams, have similar mechanisms. They are most effective against rapidly growing organisms forming cell walls. Why is clavulanate added to amoxicillin? - ANSWER Because of increasing beta-lactamase production among gram-negative pathogens and anaerobes, amoxicillin and ampicillin are often combined with beta-lactamase inhibitors, clavulanic acid, and sulbactam, respectively, for enhanced gram-negative and anaerobic activity. Beta-lactamase inhibitors prevent the destruction of beta-lactam antibiotics by serving as a competitive inhibitor of beta-lactamase. What antibiotics are appropriate to prescribe to children? - ANSWER Amoxicilln is the top antibiotic prescribed to children. A penicillin is usually the drug of choice for a susceptible organism because of limited toxicities. According to the American College of Cardiology and the American Heart Association, what are the guidelines related to prophylactic antibiotics prior to a dental appointment? - ANSWER A joint task force from the American College of Cardiology and the American Heart Association recently published a document that currently recommends therapy only for those with prosthetic heart valves, previous infective endocarditis, certain patients with congenital heart disease, and cardiac transplant patients with valve regurgitation who are undergoing dental procedures that involve manipulation of either gingival tissue or the periapical region of the teeth. Patients with CHD who require prophylaxis include CHD repaired prophylaxis include those with unrepaired cyanotic CHD, completely repaired first 6 months after repair, and repaired CHD with residual effects at the site of the prosthetic patch or device. What patient teaching will you provide to a patient who is experiencing non- infectious diarrhea related to antibiotic administration? - ANSWER If severe diarrhea occurs, the patient should contact the prescriber before initiating any treatment. For mild diarrhea, they can also use adsorbent antidiarrheal agents containing attapulgite (e.g., Donnagel) but should avoid antiperistaltic agents that promote the retention of toxins. A patient is taking a fluoroquinolone; what are the most serious adverse effects? - ANSWER All fluoroquinolones have a Black-Box Warning regarding the risk of tendon rupture and tendonitis. The risk is increased in older patients; in patients taking coritocosteroids; and patients with heart, kidney, or lung transplant. An additional Black Box Warning has been issued for all fluoroquinolones to avoid this class in patients with myasthenia gravis. What population should not be administered tetracyclines and why? - ANSWER There are a number of patients for whom tetracyclines should be prescribed cautiously; such patients include those with renal impairment, those with hepatic impairment, pregnant women, lactating women, and children under the age of 8 years old. Doxycycline is Pregnancy category D. Others are Pregnancy category X and should not be used during pregnancy. They readily cross the placenta in concentrations up to 60% of maternal plasma. Tetracyclines are found in fetal tissue and can produce retardation of skeletal development in the fetus and staining of deciduous teeth. Children younger than 8 years generally should not use any tetracycline. These drugs form a stable calcium complex in any bone forming tissue, decreasing bone growth. They also may cause permanent yellow/gray/brown discoloration of deciduous and permanent teeth. Enamel hypoplasia has also been reported. Doxycycline is less likely to produce these problems, but the risk outweighs any potential benefit for most indications. What are the most common drug interactions with levofloxacin? - ANSWER Levofloxacin should not be used with NSAIDs, concurrent use increases CNS stimulation and seizures. A patient is administered gentamicin and complains of sudden hearing loss. What should the nurse practitioner do? - ANSWER Stop the medication the patient is experiencing ototoxicity. Which medications interact with linezolid? - ANSWER Andrenergic drugs (sympathomimetic—dopamine and epinephrine) Effect: increased action of the interacting drug Reduce and titrate initial doses of interacting drug, monitor blood pressure --------------------------------------------- MAOIs Increased risk of serotonin syndrome Discontinue interacting drug 2 weeks before starting linezolid -------------------------------------------- Serotonergics (e.g., SSRIs) Development of serotonin syndrome Watch for serotonin syndrome indications. Avoid concurrent use unless no appropriate alternative. ----------------------------------------- Tyramine rich foods and drinks Significantly increased blood pressure No need to delete entirely from diet, but quantities of tyramine eaten should not exceed 100mg/meal What is the course of treatment with doxycycline for the treatment of Lyme Disease? - ANSWER Doxycycline, 100mg twice daily is the first line drug of choice for early treatment of Lyme disease, a tick borne infection caused by B. burgdorferi. What are the main side effects of doxycycline? - ANSWER Can cause phototoxicity, so sunlight and tanning lights should be avoided. Wear sunscreen, hats, and protective clothing if necessary to be in the sun for more than a few minutes. Differentiate between oral and parenteral vancomycin Differentiate between oral and parenteral vancomycin. - ANSWER Absorption of vancomycin form the GI tract is poor, although clinically significant serum concentrations have occurred. When administered intravenously, onset of action is rapid, with peak concentrations in 1 hour and a duration of effect of approximately 12 hours, depending on renal clearance. It is 52% to 56% protein bound and has less than 1% bioavailability by the oral route. Its half-life is 4 to 6 hours in adults and 2 to 3 hours in children. Distribution is wide, with 20% to 30% penetration of the CSF. The drug crosses the placenta. What is the mechanism of action of azithromycin? - ANSWER Binds to the P site of the 50S ribosome subunit of susceptible organisms and may inhibit RNA-dependent synthesis by stimulating the disassociation of peptidyl-tRNA from ribosomes. These drugs are typically bacteriostatic but may be bactericidal depending on drug concentrations and the bacterial species tested. Macrolides are weak bases, and their activity increases in alkaline media. Which antibiotics block bacterial protein production? - ANSWER Tetracyclines inhibit protein synthesis by reversibly binding to the 30S subunit of the bacterial ribosome and preventing the addition of amino acids to growing peptides. What vitamin will decrease peripheral neuropathy? - ANSWER Vitamin B12 or folate vitamin supplementation will decrease peripheral neuropathy. What lab values should be assessed when administering valacyclovir? - ANSWER BUN and serum creatinine may be assessed prior to therapy in those with risk factors for renal impairment and periodically during prolonged therapy to detect changes in renal function. When should oseltamivir phosphate be prescribed? - ANSWER Tamiflu is used for the prophylaxtic treatment of influenza A and B. For what is rifampin prescribed? - ANSWER Tuberculosis, particularly in patients with HIV Rifampin is also used to treat several nonmycobacterial infections. It is used as prophylaxis for close contacts of people with meningococcal infections caused by N. meningitis. Prophylaxis for H. influenzae type b Off label treatment of leprosy What are the adverse effects of isoniazid (INH)? - ANSWER Elevated AST/ALT levels are observed in 10% to 20% of patients taking isoniazid. A small group of patients may progress to progress to hepatic failure or necrosis. The symptoms are those usually associated with the function of development of hepatitis, including abnormal liver function studies, jaundice, and fatigue. When is prophylactic oseltamivir recommended? - ANSWER The only strongly recommended for prophylaxis, particularly when an unvaccinated high risk patient is exposed to influenza. When prescribing ketoconazole, how should it be administered? - ANSWER Maximal daily dosage is 1g. Therapy should be continued 1-2 weeks in candidiasis (3-5 days in vaginal candidiasis). Take with food to promote GI absorption and decrease GI irritation. In patients with hypochlorhydria or achlorhydria take with an acid drink. May be dissolved in cola or seltzer water or taken with these fluids. Shake suspension well before measurement using a calibrated liquid measuring device. Store at room temperature. What is hypochlorhydria? - ANSWER Low amount of stomach acid produced in the GI system What lab values should be monitored when administering antifungal agents? - ANSWER Prompt recognition of liver injury is essential with oral antifungal drugs. AST, ALT, alkaline phosphatase, and bilirubin should be monitored prior to initiation of therapy, monthly for 3 to 4 months, and frequently thereafter during treatment. Monitoring of serum azoles is recommended as well. Identify which antihelmintic is used to treat parasitic worms. - ANSWER Benzimidazoles bind to B-tubulin of the microtubule causing polmerization and loss of function in the parasite. Also have a range of inhibitory mechanism including glucose uptake. Pyrantel is a depolarizing neuromuscular blocking agent that creates spastic paralysis in the worm, it also inhibits cholinesterases. Ivermectin binds selectively to glutamate-gated chloride ion channels of the muscle and nerve resulting in hyperpolarization, paralysis, and eventual death of the parasite. Intestinal nematodes---mebendazole and pyrantel Tissue nematodes--mebendazole, albendazole, or ivermectin What antifungal medications can be used topically to treat fungal infections? - ANSWER •Nystatin •Clotrimazole •Ketoconazole •Econazole and Oxiconazole •Terbinafine and Naftifine •Tolnaftate •Butenafine •Ciclopirox What are the main side effects of ethambutol? - ANSWER GI disturbances Optic neuritis, which appears to be dose related. S/S include--decreased visual acuity, red-green color blindness, diminished visual fields, and sometimes loss of vision Precipitation of gouty arthritis (elevated uric acid levels) Transient impairment of liver function Infrequent peripheral neuropathy What medication is used to treat scabies? - ANSWER Ivermectin may be prescribed off-label to selected patients with scabies. It is effective in treating scabies in patients who are immunocompromised. The dose is 200 mcg/kg given in a single dose. Because Ivermectin is not ovicidal, it should be repeated in 1 to 2 weeks. What are the side effects of rifampin? - ANSWER Hepatotoxicity leading to hepatitis occurs with rifampin. A harmless orange-red discoloration of body fluids including tears, saliva, urine, sweat, CSF, and feces also occurs. Hematuria should not be confused with this discoloration because of hematuria may be an indication of a hypersensitivity reaction. [Show More]

Last updated: 1 year ago

Preview 1 out of 11 pages