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NR 566 MIDTERM EXAM (2 LATEST VERSIONS
2024 - 2025) / NR566 MIDTERM EXAM
REVIEW /LATEST ADVANCED
PHARMACOLOGY FOR CARE OF
FAMILY|AGRADE
Community_Acquired_Pneumonia_-Common_Pathogens-Correct_answer~- S._pneumoniae
- Mycoplasma_spp.
- H._influenzae
- Staphylococcus_aureus Community_Acquired_Pneumonia_- 1st_line_treatment_for_previously_healthy_adults_and_what_to_give_if_1st_drug_didn 't_work?- _Correct_answer~_1st_line:_Amoxicillin,doxycycline_and_macrolide(Azithromycin) Second_choice:Levaquin(Fluroquinolones) Treatment_for_M.Pneumoniae_in_pediatric_patients?- _Correct_answer~_Macrolides:_Azithromycin,_Erythromycin,_Clarithromycin
Treatment_of_community_acquired_pneumonia_in_pregnancy_- _Correct_answer~_Amoxicillin,_cephalosporins,_or_erythromycin If_someone_has_been_treated_w/an_antibiotic_in_the_previous 90 days_of_contracti ng_CAP,a_quinolone_would_be_prudent_choice_to_prescribe.Be_familiar_with_drug examples_w/n_the_antibiotic_class-Correct_answer~"floxacin" Genifloxacin Ciprofloxacin Treatment_of_chlamydial_pneumonia_in_an_infant?- _Correct_answer~Erythromycin_12.5_mg/kg_PO_QID_x 14 days When_to_use_a_broad-spectrum_anitbiotic?-Correct_answer~-before_cultures_result
- critically_ill_patient
- empiric_therapy
- pathogen_is_unknown_or_multiple_types_of_bacteria_suspected
- Gram_+cocci_and_Gram-Bacilli Narrow-spectrum_antibiotics-Correct_answer~- active_against_only_a_few_species_of_microogranisms
- used_when_pathogen_is_known
- reduces_risk_of_disruption_of_normal_flora_and_development_of_antibiotic_resistance
- preferred_when_possible
- Gram_+_cocci,Gram-_bacilli,gram-_aerobes,mycobacterium_TB Empiric_antibiotics-What_are_they?-_Correct_answer~_Broad_spectrum_antibiotics
Cephalosporins_-Patient_Education-Correct_answer~- Do_not_take_if_allergic_to_penicillin
- Interacts_w/alcohol(disulfiram-like_reaction)
Interacts_with_Vitamin_K_clotting_factors_(Can_promote_bleeding_esp._w/_NSAIDs,_th rombolytics,_and_anticoagulants)
- Increases_risk_for_C._Diff,notify_provider_of_increased_stool_frequency Cephalosporins-Pregnant_patients-_Correct_answer~Safe_to_prescribe Tetracyclines-patient_education-Correct_answer~- Do_NOT_administer_w/_calcium_supplements,_milk_products,_Iron_supplements,mag nesium(contain_laxatives),_most_antacids)
- Avoid_prolonged_sun_exposure_
- most_common_side_effect:n/v,diarrhea(take_with_meals_to_avoid) Tetracyclines-Prescribing_in_pregnant_patients- _Correct_answer~can_cause_fetal_harm_and_permanent_staining_of_infants_teeth AVOID Macrolides-Patient_education-Correct_answer~- can_cause_QT_prolongation_and_risk_for_torsades_de_pointes
- GI_effects:_n/v,diarrhea(take_with_meals_to_avoid_this) Aminoglycosides-patient_education-Correct_answer~- caution_when_combining_w/_nephrotoxic_or_ototoxic_drugs
pt_should_report_s/s_of_ototoxicity_(hearing_impairment,_disruption_of_balance..1st signs_tinnitus_and_persistent_HA
- can_cause_irreversible_ototoxicity_
- Neurotoxic_symptoms:_numbness,_tingling,_muscle_twitching,_and_seizures
- Caution_in_patients_w/renal_impairment Sulfonamides-patient_education-Correct_answer~- complete_full_prescribed_course_
- drink_at_least_ 8 - 10 _glasses_of_water_or_non_caffeinated_fluids_per_day_to_decrease_risk_of_crystalluri a
- avoid_prolonged_sun_exposure_(photsensitivity)
- hypersensitivity_(rash)should_be_reported Sulfonamides-prescribing_in_pregnant_patients- _Correct_answer~May_cause_birth_defects_especially_in_1st_trimester Kernicterus_if_taken_near_term AVOID Gentamicin-renal_adjustments-Correct_answer~-renal_toxic
to_avoid_serious_toxicity,reduce_dosage_size_or_increase_the_dosing_interval_in_pati ents_w/kidney_disease Tinea_capitis-treatment-_Correct_answer~Oral_Griseofulvin 8 - 10 weeks_or_Terbinafine 2 - 4 _weeks
- noncirrhotic_portal_HTN
- immune_reconstitution_syndrome
- redistribution_of_adipose_tissue
- peripheral_neuropathy
- retinal_disorders_and/or_optic_neuritis
- HA,_n/v,rash Saquinavir_Risk-Correct_answer~-PR_interval_prolongation
- QT_interval_prolongation
- redistribution_of_adipose_tissue
- renewed_bleeding_in_pt's_w/_hemophilia
- abd_pain,_diarrhea,_fatigue
To_reduce_risk_of_bone_loss,pt's_should_have_adequate_intake_of_calcium_and_vita min_D PR_interval_impacts_use_of_which_HIV_drugs?- _Correct_answer~Protease_inhibitors:
- Saquinavir
- Atazanavir
- Lopinavir
- Ritonavir How_to_measure_success_with_antiretroviral_therapy_for_HIV?_-Correct_answer~- reduction_in_plasma_HIV_RNA._With_ART,_plasma_HIV_RNA_should_decline_to_10%_o
f_baseline_w/n_ 2 - 8 _weeks.After 16 - 20 _weeks_of_treatment,_plasma_HIV_RNA_should_reach_its_minimum
- CD4_T-cell_counts_increase What_does_an_increase_in_CD4_T-cell_indicate?_- _Correct_answer~_As_viral_load_decreases,_CD4_T- cell_counts_may_rise,_indicating_some_restoration_of_immune_function When_do_you_use_foscarnet_in_HIV+patients?-Correct_answer~Acyclovir- resistant_mucocutaneous_HSV_and_VZV_infection_in_the_immunocompromised_host. Metronidazole-patient_teaching-Correct_answer~-avoid_breastfeeding_for 12 - 24 _hours_after_treatment
- avoid_alcohol_(disulfiram_like_reaction)
- recommend_concurrent_treatment_of_partner_if_treating_STD
- Avoid_in_1st_trimester_of_pregnancy Abacavir_(Ziagen)_-Adverse_Effects-Correct_answer~- Lactic_acidosis_and_hepatomegaly_w/_steatosis
- hypersensitivity_reaction_(Setevens_Johnson_syndrome)
- MI
Lipodystrophy_w/redistribution_of_adipose_tissue_may_occur(Cushingoid_appearance ) Monitoring_needs_for_long-term_antifungal_use_-_Correct_answer~_liver_function
- AST,_ALT,_alkaline_phosphatase,_and_bilirubin
Excessive_cerumen_in_ear_-Causes&Treatment- _Correct_answer~_Cause:pt_pushing_excessive_cerumen_further_into_the_ear_canal while_cleaning Treatment:_Irrigation_of_the_ear_canal_w/_warm_water_or_saline.Can_use_Debrox_a nd_OTC_medication_of_carbamide_peroxide_to_soften_ear_wax_for_easy_removal.It does_not_prevent_AOE How_to_treat_otomycosis- _Correct_answer~Thorough_cleansing_and_application_of_acidifying_drops
- 2%acetic_acid_solution_applied 3 - 4 times_a_day_for 7 days An_antifungal_drug_solution_may_be_used_when_acidifying_drops_are_not_effective. Neither_antibiotic_ear_drops_or_oral_antibiotics_are_indicated_as_the_first_course_of_ treatment How_to_treat_acute_otitis_media_-Correct_answer~- Pain_medication_and_some_should_get_antibiotics
- All_children_younger_than_ 6 _months_should_receive_antibiotics,_regardless
- Amoxicillin_alone_or_in_combo_w/clavulanate Treatment_in_pediatric_patient_for_acute_otitis_media-_Correct_answer~_Non- severe:amoxicillin 40 - 45 mg/kg_BID Severe:Amoxicillin 45 mg/kg_BID_plus_Clavulanate_3.2_mg/kg_BID Allergic_Rhinitis-Monoclonal_antibody_drug_treatment_option- _Correct_answer~Omalizumab(Xolair)
How_to_treat_glaucoma_in_someone_with_COPD_or_asthma_- _Correct_answer~_Betaxolol
- beta_selective_meaning_that_it_has_less_chance_of_causing_bronchial_constriction Latanoprost_-Side_effects-Correct_answer~- heightened_brown_pigmentation_of_the_iris_and_eyelid Glucocorticoids_-therapeutic_action_in_allergic_reactions- _Correct_answer~_Inhibit_synthesis_of_chemical_mediators,_thus_reducing_swelling,_w armth,_redness,_and_pain. Suppress_infiltration_of_phagocytes,so_damage_from_lysosomal_enzymes_is_averted. Lastly,they_suppress_the_proliferation_of_lymphocytes_and_reduce_the_immune_com ponent_of_inflammation Antihistamines-MOA-_Correct_answer~_H1_blockers_bind_selectively_to_H1- histaminic_receptors,_thereby_blocking_the_actions_of_histamine_at_these_sites H1_antagonists_do_not_block_H2_receptors.And_do_not_block_release_of_histamine_f rom_mast_cells_or_basophils Cromolyn-MOA- _Correct_answer~Prevents_release_of_inflammatory_mediators_from_mast_cells_and thus_can_decrease_all_symptoms._However,benefits_are_modest. Sympathomimetics-MOA- _Correct_answer~Activate_vascular_beta 1 _receptors_and_cause_vasoconstriction,_whi ch_reduces_nasal_congestion;_does_not_decrease_sneezing,_itching,_or_rhinorrhea
1st_line_treatment_for_Moderate_acne_- _Correct_answer~_Antibiotics:_doycycliene,_minocycline combination:clindamycin/benzoyl_peroxide_and_tretinoin 1st_line_treatment_for_severe_acne- _Correct_answer~isotetinoin_or_combination_doxycyline_and_topical_retinoid What_acne_treatment_would_be_selected_over_another?- _Correct_answer~_Mild:_topical_antibiotics_and_topical_retinoids Moderate:_Oral_antibiotics,_doxycyline_drug_of_choice._comedolytics,_retinoids,_and_a zelaic_acid,_hormonal_agents Severe:Isotretinoin Salicylic_acid-Patient_education-Correct_answer~- systemic_salicylate_toxicity_can_result_when_large_amounts_are_used_for_a_prolonged _period
- symptoms_of_toxicity:_tinnitus,_hyperpnea,_and_psychological_disturbances
systemic_effects_can_be_minimized_by_avoiding_prolonged_use_of_high_concentration over_large_arease Isotretinoin_Patient_Education-Correct_answer~-may_affect_vision_in_the_dark
- sunburn_easily
- periodic_blood_test
- need_two_forms_of_reliable_birth_control
- notify_Dr._w/_missed_period
- cannot_donate_blood_and_ 1 _month_after_treatment
- avoid_supplements_w/_vitamin_A
- avoid_alcohol
scarring_may_occur_w/_cosmetic_skin_procedures,_avoid_waxing,_laser_therapy,_derm abrasion
notify_provider_of:_severe_HA,vision_changes(other_than_night),_vomiting,_weaknes s,or_seizure(may_have_increased_pressure_in_the_brain
- symptoms_of_depression_of_thoughts_of_harming_yourself_should_be_reported
- report_problems_obtaining_or_maintaining_an_erection When_to_prescribe_an_intranasal_glucocorticoid?_-Correct_answer~- Prevent_or_suppress_the_major_symptoms_of_allergic_rhinitis:_congestion,_rhinorrhea, _sneezing,_nasal_itching,_and_erythema
Budesonide_(Rhinocort_Aqua),Fluticasone_propionate(Flonase),and_Trimcinolone(N asacort_Allergy_ 24 _hours)
- most_effect_for_prevention_and_treatment_of_seasonal_and_perennial_rhinitis Which_weight_loss_drugs_are_associated_w/a_suicide_risk_in_children,adolescents, and_young_adults?-_Correct_answer~Naltrexone Bupropion(Contrave) What_would_happen_if_lorcaserin_is_given_w/a_CYP2D6_substrate?- _Correct_answer~_When_given_w/CYP2D6_substrates(drugs_metabolized_by_CYP2D _isoenzymes)_the_serum_levels_of_the_substrates_can_be_increased._To_decrease_the
_Correct_answer~_Baseline:_assessment_to_rule_out_valvular_disorders_and_pulmonar y_HTN Ongoing:_Cognitive_changes,_CBC_w/diff.for_s/s_of_blood_dyscrasias Loarcaserin(Belviq)-patient_education- _Correct_answer~_classified_as_a_schedule_IV_drug,has_potential_for_abuse Naltrexon/bupropion(Contrave)Baseline_data_needed_and_ongoing_monitoring/asses sment_needs.- _Correct_answer~_Baseline:_Blood_glucose,_liver_function,_renal_function,_and_mental _status Ongoing:_Periodic_assessment_for_blood_glucose,_liver_and_renal_function,_s/s_of_de pression,_anxiety_or_panic_attacks,suicidal_ideation,and_mania Naltrexon/bupropion(Contrave)-patient_education- _Correct_answer~_decreases_the_effectiveness_of_opioid_analgesics,_increased_risk_of _suicide_in_children,_adolescents,_and_young_adults. Caution_in_those_taking_or_discontinuing_Wellbutrin._Can_cause_severe_neuropsychiat ric_reactions,_including_depression,_mania,_psychosis,and_homicidal_ideation How_to_D/C_phentermine_and/or_topiramate- _Correct_answer~if_a_pt_who_is_taking_phentermine_and_topiramate_has_not_lost 5 %of_weight_by 6 _months,the_drugs_should_be_discontinued_and_taper_off_medicat ion Topiramate-therapeutic_effect-_Correct_answer~_Induces_a_sense_of_satiety
Orlistat_-patient_education-Correct_answer~- take_daily_multivitamin_supplement_to_acoid_vitamin_A,D,E,_and_K_deficiency
administration_of_vitamin_should_be_done_ 2 hours_before_or 2 _hours_after_taking_o rlistat
Reduces_fat_absorption;stools_are_fatty_or_oily_and_fecal_incontinence_can_occur.(B ulk-forming_laxatives_can_help_w/_this_side_effect
- Pt's_must_have_a_calorie_diet_w/_30%_fat_content
- taking_the_drug_more_often_does_not_increase_weight_loss
- may_cause_hypothyroidism_in_pt;s_taking_levothyroxine_-administer 2 _hours_apart
- monitor_coagulation_and_may_need_to_reduce_warfarin_dose
- take_Orlistat_w/food Orlistat_side_effects- _Correct_answer~_associated_w/_rare_cases_of_severe_liver_damage
s/s_include_itching,_vomiting,_jaundice,_anorexia,_fatigue,_dark_urine,_and_light_color ed_stools
- Pt's_who_experience_these_s/s_should_report_immediately
- D/C_until_liver_injury_has_been_ruled_out Tetracycline_common_dose_-_Correct_answer~Adults:1,000-2,000_mg_PO_q6h Children_older_than 8 years: 25 - 50 mg/kg_PO_q6h Tetracycline_indications-Correct_answer~- Rickettsial_diseases(Rocky_Mountain_spotted_fever,_typhus_fever,_Q_fever
Benzoyl_Peroxide_Cream_Indication_-_Correct_answer~_Mild_to_moderate_acne
