NUR 635 Midterm Exam (GRADED A) Questions and Answers (100% Correct Elaborations)

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Often prescribed with levodopa/carbidopa in the treatment of Parkinson's Disease Bromocriptine What medication may cause serious or possibly life-threatening sleep behaviors, such as sleep drivi... ng? Ambien Taking too much of this type of drug can make you "blind as a bat" or "mad as a hatter" Anticholinergics, antimuscarinics Absorption, Distribution, Metabolism, excretion Pharmacokinetics Drugs used to relieve a myasthenic crisis Neostigmine, pyridostigmine This drug has a very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently Lithium The drug class that carries an increased risk of suicidality in children, adolescents, and young adults SSRIs/SNRIs The antidote for organophosphate poisoning Atropine This drug class double the rate of mortality in older adults with dementia Antipsychotics In infants, this is not fully developed and therefore infants are more sensitive to CNS drugs Blood Brain Barrier Time of development that fetus is at highest risk of teratogenicity from a drug First trimester Do not stop this class of drug abruptly due to an increased risk of cardiovascular events Beta-blockers Agents that indirectly block the breakdown of acetylcholine and are often used in treatment of Alzheimer's Disease Cholinesterase inhibitors Adverse drug reaction that causes difficulty speaking and chewing and worm-like movements of the tongue Tardive Dyskinesia Receptor found in the lungs that causes bronchodilation when activated Beta 2 Receptors This drug has led to the death of children in ultrarapid metabolizers as 10% of the drug is converted to morphine Codeine Leading cause of acute liver failure in the U.S. Hepatotoxic drugs An autoimmune disease that attacks the nicotinic receptors in skeletal muscle Myasthenia Gravis An opioid antagonist that works to quickly reverse CNS and respiratory depression Naloxone (Narcan) How the drug affects the body Pharmacodynamics Term for the amount of drug that reaches systemic circulation. Often affected by route of administration Bioavailability Symptoms for this syndrome include confusion, irritability, tachycardia, hypertension, diaphoresis, and is caused by having too much of this "happy" substance Serotonin Dopamine agonist often used in treatment of Parkinson's Disease that is least likely to cause sleep attacks Pramipexole Clonidine is often prescribed to children to treat this disorder ADHD Drug most effective in alcohol withdrawal Lorazepam (ativan) Drug used for anaphylactic reaction or cardiac arrest Epinephrine 1st line drugs for migraine prevention Beta Blockers Parasympatholytic used for unstable bradycardia Atropine Drug class used to treat ADHD Stimulants Drugs that have no medical use and high potential for abuse Schedule I controlled substances This drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly Baclofen 3Muscle relaxant that is also a schedule IV controlled substance Carisoprodal (Soma) 1st line abortive drug class for mild to moderate headaches NSAIDs 1st line abortive drug for moderate to severe migraine headaches Sumatriptan (Imitrex) Used in the treatment of non-hypovolemic hypotension Norepinephrine or phenyleprine Drug used for acute management of seizures Lorazepam Used for treatment of beta-blocker overdose Glucagon Used in treatment of opioid use disorder. May cause QT prolongation. Methadone This opioid analgesic is used for treatment of post-op shivering or rigors Meperidine Antiseizure medication that carries Black Box warnings for severe skin reactions such as SJS Carbamazepine Drug class used to treat extra-pyramidal symptoms Anticholinergics Cause of menstrual-associated migraines Drops in estrogen levels Chronic use may cause amotivational syndrome or hyperemesis synrome Marijuana (THC) Deadly bacterial toxin used in prevention of chronic migraine headaches Botox (Botulinum toxin) Neostigmine is a medication used to treat what disorder/disease? Myasthenia Gravis Myasthenia Gravis is an autoimmune disorder that may cause what symptom? Difficulty swallowing True or false: in order for a medication to affect the CNS, it must be able to cross the blood brain barrier? TRUE A major goal in treating Parkinson's Disease is to restore what in the brain? Dopamine Common side effects of dopaminergics? Sleep attacks, hallucinations, confusion Which medication is appropriate in the treatment of acute psychosis? Haloperidol After being treated with a first-generation antipsychotic, the patient develops difficulty speaking and chewing likely due to which adverse reaction? Tardive Dyskinesia Which medication can help manage daily panic attacks? SSRIs Cholinesterase inhibitors are used in the treatment of what condition? Alzheimer's Disease True or false: anticonvulsants are only used to treat seizure disorders? FALSE This antiseizure medication is also used for prophylactic treatment of migraines: Topiramate This anti-seizure medication is also an anti-arrhythmic: Phenytoin (Dilantin) Which antiseizure medication has a Black Box warning for blood dyscrasias and serious dermatologic reactions? Carbamazepine (Tegetrol) Which agent should you try first to treat an early onset migraine? NSAIDs Hallucinations may occur if this medication is stopped abruptly? baclofen Sedative hypnotics are often used for insomnia. A common agent used is: zolpidem Atomoxetine (staterra), clonidine and guanfacine are used in the treatment of which disorder? ADHD Initial intervention for infrequent migraine headaches includes: headache diary Which medications cause QT prolongation? amiodorone, methadone, tricyclic depressants A contraindication for a triptan includes: hypertension, MAOI, CAD Your friend breaks out in hives and has wheezing after eating PB, what do you do? Epinephrine IM (epi-pen) Beta blockers have been used for: post MI, HTN, HF What drug route allows for 100% bioavailability? Intravenous Chronic renal failure will affect what element of pharmacokinetics? excretion TRUE OR FALSE: Andrenergic antagonists or alpha blockers cause vasoconstriction? false Symptoms of BPH include: urinary hesitation common side effect of ACE inhibitors: cough TRUE OR FALSE: angina pain is caused by cardiac ischemia? true All patients with angina should receive this medication to reduce mortality? Aspirin Lifestyle modifications to reduce cardiac risk include: stop smoking, daily exercise, weight loss (at least 10 pounds) a patient with heart failure that has anginal pain with walking and slight limitation of activity is what class? II A patient is taking HCTZ (hydrochlorothiazide) for HTN. What lab is most important to monitor? potassium (K) TRUE OR FALSE: one primary mechanism that worsens heart failure is cardiac remodeling? TRUE Which class of medication is indicated in patients post MI to precent cardiac remodeling? ACE inhibitors TRUE OR FALSE: when treating hyperlipidemia, calculating ASCVD risk will help to determine treatment? TRUE Which class of medication is contraindicated in patients with liver failure? HMG-CoA inhibitors (statins) Which anticoagulant has the quickest onset of action? heparin Patients receiving heparin are at risk for what adverse reaction? thrombocytopenia Why would heparin and warfarin be given together? warfarin has a delayed effect All of the following could increase a patient's ability to bleed: herbal supplements, aspirin, TPA Factor Xa levels may be monitored for patient's on this medication? low molecular weight heparin Which blood pressure medication can be taken during pregnancy? beta blockers after a hip replacement, what drug is often used to prevent DVT? enoxaparin A patient started on warfarin for A-fib should be taught that... the INR should be between 2-3 What is not true about epoetin alfa? treats patients with pernicious anemia Pernicious anemia is due to deficiency of B12 Lab monitoring for iron deficiency anemia include the following reticulocyte count in 1 week, TIBC in 4 weeks, Hgb/Hct/ferritin in 4 weeks Which class of antidiabetic medication is contraindicated in CKD stage 4, 5 metformin A pregnant diabetic woman wants to know if she should continue her diabetes medication, you tell her she will be switched to insulin during pregnancy metformin helps to control blood glucose levels by decreasing glycogenolysis by the liver, reduces glucose absorption in the gut, increasing skeletal muscles uptake of glucose When starting a basal insulin, which class of medication should you reduce or d/c? sulfonylurea TRUE OR FALSE: beta-blockers can mask effect of hypoglycemia TRUE TRUE OR FALSE: alcohol can mask the signs and symptoms of hypoglycemia TRUE Signs and symptoms of hypoglycemia include: confusion, tachycardia, diaphoresis A diabetic patient has developed hypertension, which class of medication should be started? ACE inhibitor Levothyroxine should be taken at what time of day? first thing in the morning, 30 minutes prior to eating How would you know effectiveness of levothyroxine Decrease in TSH levels Which form of estrogen has the least side effects? transdermal a post-menopausal woman is being seen for HRT, what questions should you ask? Do you smoke cigarettes? Hx of DVT/PE? Hx of hysterectomy? Your male patient on testosterone has had a 7 pound weight gain and needs early refill on testosterone, you suspect? he is using more than prescribed What should you avoid while taking the antibiotic metronidazole (Flagyl) to avoid adverse effects? Alcohol What medication class can be used to treat BPH? Alpha blockers Why would we recommend for a patient to take an aspirin daily? Stroke, MI, PE prevention What is a big side effect of too much aspirin? Bleeding What should you monitor closely for an anemic patient getting epoetin? Blood pressure (HTN) What is the black box warning for epoietis-stimulating agents (ESAs) They can cause tumors If a patient is diagnosed with angina, what medications should they take? aspirin, statins, nitro If you have someone who wants to self-donate, what would we prescribe to them to stimulate red blood cells? Epoetin WITH iron If prescribing iron, what labs do we want to get and how long out should we get them? Reticulocyte count within 1 week TIBC, H&H, ferritin - 4 weeks What education should we provide to someone needing iron replacement? Take on an empty stomach with orange juice (vit. C helps with absorption) and it can cause GI upset In a patient with pernicious anemia receiving Vit B12, what should we monitor? Potassium (hypokalemia can occur within first two days) How long does it take NPH to take effect? 60-90 minutes What is the biggest side effect to monitor for when treating diabetics with insulin or oral agents? Hypoglycemia (tachycardia, diaphoresis) Why can beta blockers and alcohol not be taken together? Masks signs of hypoglycemia If we are switching a patient from NPH to glargine, what do we need to do with the glargine dosing? Decrease by 20% to prevent hypoglycemia What to monitor when starting metformin? Renal function tests Why are gliptins different from other anti-diabetic medications? They act on the incretin system (indirectly increasing insulin production) How do GLP-1 agonists work? Directly bind to receptors in pancreas What are the NYHA stage classifications for HF? Stage 1 Stage 2 - angina with exertion Stage 3 - severe symptoms w/minimal or no activity Stage 4 - symptoms at rest - need intervention What is the biggest lifestyle change needed for an angina patient? weight loss (diet/exercise) What are the two reasons patients go into heart failure? MI & myocardial ischemia What can you not take with flagyl? Alcohol If giving any medication that can cause hepatotoxicity, what should you monitor for labs? LFTs Why do PAs/NPs have prescription authority? more access to care When is it most dangerous for a pregnant woman to consume teratogenics? 1st trimester What should we educate our breastfeeding moms to do if we have to prescribe a medication that could potentially be harmful? Take the medication immediately after breastfeeding Why would we give neostigmine and what do we need to monitor prior to starting this medication? Myasthenia Gravis - monitor swallowing ability Why would a pediatric patient receive clonidine? ADHD What are the big side effects of Parkinson Drugs? EPS, risky behaviors, hallucinations, sleep attacks What medication can be added to Levidopa/Carbidopa? Bromocriptine (need to decrease dosing when adding) Why do CNS drugs cause sleepiness? because they cross over the blood brain barrier What can happen if you abruptly stop taking baclofen? hallucinations Who do we give baclofen to? Spasticity patients - MS, SCIs, cerebral palsy What is Rivastigmine? For alzheimer's disease - transdermal patch changed daily If a patient has frequent migraines, what meds can we give for prevention? Propranolol (not for asthmatics), topamex If prescribing oxycodone and a patient states that this medication does not work for them anymore, what would you do? change to something stronger/longer acting What can methadone change physiologically? QT prolongation What is the biggest side effect of first generation antipsychotics? Tardive dyskinesia If a patient is being switched from an MAOI to an SSRI, what needs to happen? stop one for two weeks before starting the other What kind of drug should be given to someone who suffers from panic attacks? SSRIs If giving HRT for postmenopausal women, which dosing preparation should we utilize? Transdermal - less side effects Oral contraceptive choice for a teenage girl who is noncompliant with daily pills? Medroxy-progesterone acetate (depo) What should you do for a women on an OC who has a major surgery coming up? switch her to a progesterone only medication to lower risk of clots What do we prescribe androgen therapy for? If they start gaining weight, why is this a concern? Hypogonadism patients - check levels they may not be receiving a high enough dose How do we know if a BPH medication is effective? Easier urination [Show More]

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