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NURS
NURS 617/ NURS 617 EXAM 3: (NEW 2025/ 2026
UPDATE) PHARMACOTHERAPEUTICS GUIDE| QS & AS|
GRADE A| 100% CORRECT (VERIFIED ANSWERS)-
Possible long term effects of estrogen-progesterone combo contraceptives.
- ANS ✓Increased risk for thromboembolism, stroke, M.I May cause or increase risk for hypertension Possible increased risk for endometrial and breast cancer May cause risk of benign hepatic tumors Small possibility of post-pill infertility or amenorrhea Advantages of medroxyprogesterone injection compared to "the pill" - ANS ✓Eliminates the need for daily self-medication; improves compliance and success Eliminates the possibility of drug-drug interactions with other orally administered drugs Eliminates the adverse effects associated with estrogen Disadvantages of medroxyprogesterone injection - ANS ✓Causes menstrual irregularities requires IM injection Can cause weight gain Can cause headaches, nervousness and may worsen depression.
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Advantages of ERT - ANS ✓Produces reversal or improvement of vasomotor symptoms of menopause (sweating, subjective hyperthermia or hot flashes, chills), mood swings, and insomnia Produces reversal of genital (vaginal) atrophy in younger patients; may eliminate dysparuenia Prevents loss of bone density May improve libido Decreases serum LDL cholesterol Increases HDL cholesterol Can produce cosmetic benefit by way of improved skin texture Disadvantages of ERT - ANS ✓Can cause vaginal bleeding Commonly causes breast tenderness Can cause nausea and vomiting when therapy is initiated May cause headache, migraine, dizziness May produce weight gain Associated with an increased risk of breast cancer, endometrial cancer, myocardial infarction, stroke and deep venous thrombosis First line therapy for Sinusitis - ANS ✓amoxicillin with or without clavulanate (Alternative—cefuroxime, cefpodoxime, azithromycin)
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First line treatment for complicated UTI in pregnancy suitable for outpatient treatment - ANS ✓Cephalexin 2nd line-Nitrofurantoin as long as patient is in 2nd trimester First line therapy of UTI in an afebrile child >1 month old - ANS ✓TMP/SMZ or cephalexin First line therapy of UTI in a febrile child >1 month old - ANS ✓Ceftriaxone, cefotaxime, or ceftazidime given parenterally until afebrile or for first 24 hours. First line treatment for Pharyngitis - ANS ✓PCN G or Amoxicillin; if allergic to PCN: type 1 hypersensitivity reaction use clindamycin not type 1 hypersensitivity reaction use 1st gen cephalosporin (Cefazolin, cefadroxil, cefalexin) First line treatment for CAP in a previously healthy adult with no history of abx use in the last 3 months - ANS ✓Azithromycin or Clarithromycin; if allergic to macrolides use doxycycline
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First line treatment of CAP in adults with comorbidities or with use of abx in the last 3 months - ANS ✓Levofloxacin, Moxifloxacin, or gemifloxacin alternative is use of a beta lactam (high dose amoxicillin-clavulanate is preferred) PLUS a macrolide (azithromycin, clarithromycin) can replace macrolide with doxycycline if allergic. Parenteral treatment of Pneumonia - ANS ✓Ceftriaxone When should patients begin to exhibit signs of improvement when being treated for CAP - ANS ✓ 48 - 72 hours First line treatment of CAP in pregnant patients - ANS ✓Azithromycin or Erythromycin; if recently treated with abx or with comorbidities use beta lactam+macrolide First line treatment of chlamydial pneumonia in children - ANS ✓Erythromycin or Azithromycin First line treatment of S.Pneumoniae bacterial pneumonia in children - ANS ✓High dose amoxicillin If highly resistant pneumococci are in the community then use IV or IM ceftriaxone or cefotaxime
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Drug of choice for otitis media - ANS ✓Amoxicillin Drug of choice for endocarditis prophylaxis - ANS ✓Amoxicillin Drug of choice for staphylococcal skin infections - ANS ✓Dicloxacillin, Oxacillin, and Nafcillin Drug of choice for chlamydia - ANS ✓Azithromycin What medications are known to cause C Diff - ANS ✓Clindamycin, 2nd and 4th generation cephalosporins, Linezolid, tetracyclines, Drug of choice for C Diff - ANS ✓Metronidazole Which antibiotic drug classes are contraindicated in pregnancy - ANS ✓Tetracyclines, Fluoroquinilones, Metronidazole (1st trimester), 3rd generation cephalosporins, Nitrofurantoin ( 1st trimester) What are some serious adverse effects of Sulfonamides - ANS ✓Crystaluria leading to nephrotoxicity Photosensitivity
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Stevens-Johnson syndrome haemolytic anaemia, granulocytosis, thrombocytopenia What medication is used to treat drug resistant Staph, VRE, and PCN resistant strep - ANS ✓Streptogramin (Quinupristin/Dalfopristin) Which medications can cause a disulfiram-like reaction when taken with alcohol - ANS ✓2nd generation cephalosporins and metronidazole What are some adverse effects of Tetracyclines - ANS ✓discoloration of permanent teeth, photosensitivity , alteration of the intestinal and vaginal flora, diarrhea, vaginal candidiasis ,coagulation irregularities, blue grey pigmentation of skin, pseudotumor cerebri, Stevens-Johnson syndrome. What drug-drug interaction occurs with tetracyclines and divalent/trivalent cations - ANS ✓Coadministration of tetracyclines and antacids, iron salts, sevelamer, or Mg containing laxatives decreases the antibiotic activity and these medications should be given at least 2 hours apart. Contraindications for use of Tetracyclines - ANS ✓Renal failure (except Doxycycline/Vibramycin) No children under 8
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Hemolytic anemia Acute and Chronic pulmonary reactions peripheral neuropathy What antibiotics are bactericidal - ANS ✓Penicillins Cephalosporins Fluoroquinolone Macrolides (to some organisms in large doses) Nitrofurantoin Oxazolidinone (for most strains of strep) Vancomycin Aminoglycosides Metronidazole What antibiotics are bacteriostatic - ANS ✓sulphonamides tetracyclines clindamycin macrolides Oxazolidinone (for MRSA) Which antifungal drugs can be used for systemic illnesses - ANS ✓Ketoconazole
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Fluconazole Itraconazole Voriconazole Caspofungin Terbinafine Which antifungal drugs are only used for superficial infections - ANS ✓Nystatin Clotrimazole Miconazole What is the drug of choice for vaginal, esophageal, urinary and oropharyngeal candidiasis - ANS ✓Fluconazole Drug of choice for invasive aspergillosis - ANS ✓Voriconazole Treatment for Candidemia - ANS ✓IV fluconazole or IV Capsofungin Which anti-fungal drugs cannot be used in pregnancy - ANS ✓fluconazole itraconazole voriconazole anidulafungin
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Lower doses and longer intervals are recommended for those with CV disease or long standing hypothyroidism. How to determine appropriate dosage size for Levothyroxine - ANS ✓For adults with no CV impairment start at 50mcg/day and increase by 25mcg every 2 - 4 weeks. For Older adults with no CV impairment start at 25-50mcg and increase by 12.5- 25 mcg every 6-8 weeks Lower doses and longer intervals are recommended for those with CV impairment and those with long standing hypothyroidism. Therapy is decided by TSH levels as well. Most adults require a dose less than 200mcg and a dose of >300mcg lack of adherence or malabsorption. What drugs are capable of having a drug-drug interaction with Synthroid. - ANS ✓Potentiates effects of adrenergic agonists. May inhibit adrenergic blocking drugs Which medication is best for chronic hypothyroidism - ANS ✓Levothyroxine Which thyroid medication is most cardiotoxic - ANS ✓Liothyronine
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Which thyroid medication has the disadvantage of not having content stability - ANS ✓Liotrix What are some advantages of Liothyronine over Levothyroxine - ANS ✓Liothyronine has a faster onset of action and is more potent. Advantage of using Levothyroxine over Liothyronine - ANS ✓Less cardiotoxic and has a longer duration of action meaning that even if some doses are missed thyroid levels can remain therapeutic. What are some signs of Thyroid medication toxicity? - ANS ✓irritability, insomnia, tachycardia, arrhythmias, elevated blood pressure, anxiety, weight loss, all similar signs of hyperthyroidism. Which antithyroid drug is used in pregnancy - ANS ✓Propylthiouracil Which antithyroid drug has a black box warning for liver injury - ANS ✓Propylthiouracil Advantages of Methimazole over Propylthiouracil - ANS ✓Methimazole is more potent, less toxic, not protein bound, and does not carry black box warning about liver damage
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What oral hypoglycemic is preferred in pregnancy - ANS ✓Metformin Which oral hypoglycemic drug has a black box warning for CHF - ANS ✓Thiazolidinediones (zones) Special consideration when treating DM with an alpha glucosidase inhibitor and another hypoglycemic drug - ANS ✓If hypoglycemia occurs you cannot treat with oral complex sugars; can still treat with glucose. Which anti-diabetic medication can be used for both type 1 and type 2 diabetes. - ANS ✓Amylin Analogs (Pramlintide) Which anti-diabetics are contraindicated in diabetic gastroparesis? - ANS ✓Amylin analogs (pramlintide) and DPP-4 inhibitors (gliptins) Which anti-diabetic drug causes mycotic infections? - ANS ✓SGLT- 2 inhibitors (flozins) Which anti-diabetics carry a black box warning for Thyroid tumors? - ANS ✓GLP-1 analogs (tides)
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What is the most effective medication-induced contraceptive - ANS ✓Estrogen-Progesterone combo What is the least effective medication-induced contraceptive - ANS ✓Progesterone only pill
