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NR 566 Final Study Guide QUESTIONS
WITH 100% CORRECT ANSWERS.
Chlamydia
(Among Adolescents and Adults) Treatment - CORRECT ANSWER -Doxycycline
100 mg Orally BID for 7 day **Alternative therapy:
- Azithromycin 1g Orally in a single dose
- Levofloxacin 500 mg orally daily for 7 days
Uncomplicated gonococcal urethritis Treatment - CORRECT ANSWER -
Chlamydial infection is excluded: Ceftriaxone 500 mg IM single dose If Chlamydial infection has not been excluded:
- Ceftriaxone 500 mg IM single dose
- Doxycycline 100 mg Orally BID for 7 day **Alternative therapy: -Gentamicin 240 mg IM in a single dose + Azithromycin 2 g orally in a single dose
- Cefixime 800 mg orally in a single dose
Bacterial Vaginosis Treatment - CORRECT ANSWER -- Metronidazole 500 mg
orally BID for 7 days
- Metronidazole gel 0.75% one full applicator intravaginal, once a day for 5 days
- Clindamycin vaginal cream 2% one full applicator intravaginal, at bedtime for 7 days Herpes Simplex Virus
(First Clinical Episode) Treatment - CORRECT ANSWER -- Acyclovir 400 mg
orally TID for 7-10 days
- Famciclovir 250 mg orally TID for 7-10 days
- Valacyclovir 1 g orally twice a day for 7-10 days
Pelvic Inflammatory Disease (PID) (IM or Oral Regimens) Treatment - CORRECT
ANSWER -- Ceftriaxone 500 mg IM in a single dose +
Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID of 14 days
- Cefoxitin 2g IM in a single dose + Probenecid 1g orally in a single dose + Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID for 14 days
- Other parenteral third generation Cephalosporin (Ceftizoxime or Cefotaxime) + Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID for 14 days
Syphilis Treatment - CORRECT ANSWER -Benzathine Penicillin G 2.4 million
units IM in a single dose
Doxazosin side effects (due to alpha 1 receptor being blocked) - CORRECT
ANSWER -dizziness/syncope, headache, first-dose orthostatic hypotension,
drowsiness, nasal congestion
Dutasteride (Avodart) patient teaching - CORRECT ANSWER -benefits take
months to develop, must continue taking med even if improvement not rapidly seen may lower ejaculatory volume & libido Should not be handled by pregnant women as the medication is teratogenic
How to know Terazosin is working? - CORRECT ANSWER -improved symptoms
of dysuria, urgency, urinary tract infections, hesitancy etc. Improvement should occur rapidly
Oral Estrogen - CORRECT ANSWER -Most convenient and used most often.
Transdermal Estrogen - CORRECT ANSWER -Total dose of estrogen is greatly
reduced. Less nausea and vomiting, blood levels of estrogen fluctuate less. Lower risk for DVT, PE, and stroke.
Intravaginal Estrogen - CORRECT ANSWER -Used for local effects. Primarily
treatment of vulval and vaginal atrophy associated with menopause. Femring (vaginal ring) - used for systemic effects (controlling hot flashes and night sweats), as well as local effects (vulval and vaginal atrophy)
Long term: if delayed puberty related to true hypogonadism
testosterone replacement therapy side effects? - CORRECT ANSWER -Hot
flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, sterility, hepatotoxicity, mood swings/ aggression.
Alprostadil: benefits of various routes? (for ED) - CORRECT ANSWER -
Transurethral - inserted into the urethra
- Can be used twice daily
- Erection develops 5 to 10 minutes after drug insertion and lasts 30 to 60 minutes Intracavernous - direct injection into the corpus cavernosum.
- Used no more than 3 times a week and no more than once every 24 hours.
- Response is rapid and the injections are relatively painless How does carbamazepine impact oral contraceptives and what symptoms may be
associated with that? - CORRECT ANSWER -accelerates OC metabolism,
reducing OC effect can lead to abnormal bleeding, return of menstrual symptoms, and of course pregnancy!
what can the provider do is carbamazepine effecting patient's OC? - CORRECT
ANSWER -1. Increase the estrogen dosage of the OC.
- Combine the OC with a second form of birth control.
- Switch to an alternative form of birth control.
Benefits of Etonogestrel subdermal implant (Nexplanon)? - CORRECT
ANSWER -it is one of the most effective forms of contraception, long-term option
(contraception up to 5 years), reversible by removing rod
- Safe during breastfeeding after the 21st day postpartum
Papaverine plus phentolamine patient education: - CORRECT ANSWER -do not
inject more than once in a 24 hr period, notify provider of erection duration and efficacy, do not take other ED meds with this medication, needle/injection teaching, do not change the dose yourself, seek medical attention if erection is >3 hrs
Adverse effects associated with Pramipexole - CORRECT ANSWER -nausea,
dizziness, daytime somnolence, insomnia, constipation, weakness, and hallucinations. Impulse control disorder can occur (excessive gambling, spending etc.)
Sleep attacks (overwhelming and irresistible sleepiness that comes on without warning)
When is Pramipexole best used in treating Parkinson's? - CORRECT
ANSWER -- Used alone in the early stages of PD - Produces significant improvement
in motor performance
- Combined with Levodopa in advance stages of PD - Reduce fluctuations in motor control
when are COMT inhibitors indicated? (I.e. Entacapone) - CORRECT ANSWER -
If patient experiences "off" phases with their medication therapy (return of symptoms for random periods of time) extends the half-life of Levadopa
What are sleep attacks associated with Parkinsons treatment? - CORRECT
ANSWER -overwhelming/irresistible sleepiness that comes on without warning
How to manage side effects of Bromocriptine (dopamine agonist): - CORRECT
ANSWER -**Adverse effects are dose dependent
- Take with food to decrease GI upset
- start with lowest effective dose and gradually increase
- screen for hx of compulsion/sleep disturbance
what seizure meds reduce OC efficacy? - CORRECT ANSWER -carbamazepine,
eslicarbazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, topiramate
Phenytoin side effects - CORRECT ANSWER -drowsiness, ataxia
nystagmus blurred vision lethargy GI upset suicidal behavior/cognitive decline
patient teaching with Phenytoin - CORRECT ANSWER -strict adherence to
medication is important due to its narrow therapeutic range
patient teaching regarding anti-seizure meds and OC/pregnancy: - CORRECT
ANSWER -effectiveness of OC may be decreased by many anti-seizure meds, if
pregnancy is unwanted the pt should consider adding or increasing contraception.
The first dose of any triptan should be: - CORRECT ANSWER -should be under
direct supervision in case of any unknown underlying cardiac disease
Rivastigmine (Exelon) Patch Patient teaching - CORRECT ANSWER -· Change
daily (don't re-use site for 14 days) · Remove old patch before applying a new patch When would it be appropriate to increase the dose of Donepezil (Aricep)? -
CORRECT ANSWER -Dosing starts at 5 mg and titrate up to 10mg for mild to
moderate symptoms. This can go up to a maximum dose of 23 mg orally once daily at three months of treatment Donepezil at a higher dose has a higher incidence of adverse effects without increased cognitive benefit Appropriate to increase dose if symptoms increase
Cholinesterase inhibitors Side effects - CORRECT ANSWER -· Bradycardia,
lightheadedness, fainting/falls, weight loss · Dose related (increase dose gradually): Nausea, vomiting, diarrhea, abdominal pain, tremors, anorexia, insomnia When on medications for Alzheimer's Disease (AD) and symptoms increase What
should be done? - CORRECT ANSWER -Increase the AD medication than to
add things like herbal medications, vitamins, or NSAIDs What to do when someone has an elevated creatinine clearance while on Memantine? -
CORRECT ANSWER -Adjust dose for renal impairment (creatinine clearance of
less than 30mL/min), discontinue in severe renal impairment
First-line treatment options for panic disorder? - CORRECT ANSWER -SSRIs-
fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) for at least 6-9 months to prevent rebound anxiety
First-line treatment options for performance anxiety? - CORRECT ANSWER -
beta blockers- Propranolol to prevent associated tachycardia (1-2 hours before) Benzos for rapid relief
First-line treatment options for generalized anxiety disorder? - CORRECT
ANSWER -SSRIs- Paroxetine (Paxil) and Fluoxetine (Prozac)
SNRIs- Buspirone (Buspar)
Approach when first anti-depression drug doesn't seem to be working? - CORRECT
ANSWER -wait at least 4 weeks minimum before increasing/changing dose.
1st increase dose, then change drug within same class, then switch to new class, then start second med
How long should it take antidepressants to work? - CORRECT ANSWER -4-
weeks
Suicide risk associated with antidepressants: - CORRECT ANSWER -increased
risk of suicide in those taking antidepressants, especially in children and young adults never to be stopped abruptly (increases risk)
First-line treatment options for sleep disturbance? - CORRECT ANSWER -
Benzodiazepines: Triazolam Benzodiazepine-Like Drugs: Zolpidem (Ambien), Zaleplon (sonata), eszopiclone (Lunesta) Melatonin Receptor Agonist: Melatonin, Ramelteon (Rozerem) Orexin Receptor Agonist: Suvorexant (Belsomra)
Therapeutic drug level of lithium: - CORRECT ANSWER -0.6-0.8 mEq/L
Lithium drug-drug interactions - CORRECT ANSWER -•Thiazides-Diuretics-
lithium toxicity •NSAIDS- higher plasma lithium levels •Haloperidol-encephalopathic syndrome (weakness, tremors, confusion, lethargy) -Carbamazepine •anti-acids-decreases effectiveness of lithium ***
Common adverse reactions of 1st generation antipsychotics - CORRECT
ANSWER -extrapyramidal symptoms: Parkinsonism, akathisia, dystonia (all
manageable w/ anticholinergics), Tardive Dyskinesia (no treatment) dry mouth, constipation (anticholinergic effects)
pt teaching regarding first gen. antipsychotics: - CORRECT ANSWER -inform
provider immediately about any signs/symptoms of tardive dyskinesia/adverse effects
Ginkgo Bilboa Adverse Effects - CORRECT ANSWER -- Stomach upset
St. John's Wort Adverse Effects - CORRECT ANSWER -- Allergic skin reactions
- Insomnia
- Restlessness
- Dry mouth
- Phototoxicity
Ginger Root Adverse Effects - CORRECT ANSWER -- No adverse effects in
typical doses
- Excessive doses can cause potential for CNS depression and cardiac dysrhythmias
- Can also cause GI disturbance
- Use with caution in pregnancy
- Suspicious for spontaneous abortion
A patient with what type of condition should not take echinacea? - CORRECT
ANSWER -Avoid in patients with autoimmune disease
- Lupus
- Rheumatoid arthritis
Flaxseed - Patient education about administration/consumption - CORRECT
ANSWER -- Avoid in patients with hypertriglyceridemia -> may increase triglyceride
levels
- Take with a lot of fluids because it is a bulk-forming laxative **may reduce absorption of conventional medications
- Take 1 hour before or 2 hours after these drugs
Coenzyme Q-10 Therapeutic Effects - CORRECT ANSWER -Antioxidant, serves
a vital role in energy production
- Used to treat heart failure, muscle injury caused by HMG-CoA reductase inhibitors (statins), and mitochondrial encephalomyopathies
- Positive outcomes:
- Improved cardiac function
- Faster recovery after cardiac surgery
- Improve sperm count
Fever Few Therapeutic Effects - CORRECT ANSWER -Used for prophylaxis of
migraine
- Can reduce frequency and intensity of attacks
- Taken for conditions related to hypersensitivity and altered immune responses Causes:
- Inhibition of vasoconstriction in the brain
- Suppression of serotonin release from platelets and leukocytes
- Suppression of inflammation secondary to inhibition or arachidonic acid release
Laws related to CAM, know what they do - CORRECT ANSWER -- Dietary
Supplement Health and Education Act (DSHEA) of 1994o
- Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006
- Current Good Manufacturing Practices (CGMP) ruling of 2007