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FNP Review > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What medication is a contraindication for a patient with gout?

A

Thiazide diuretic INCREASE uric acid levels

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2
Q

What are PharmaKinetics changes in the older patient populations?

A
  1. Increase in fat to water ratios

2. Decrease in albumin, plasma protein, liver blood flow, liver size, CYP450 enzyme pathways, and GFR.

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3
Q

A NP knows that a certain drug slows down drug clearance. What does the NP look for?

A

Drug overdose - Over medication

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4
Q

A NP finds NSAIDS on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

reducing the renal blood flow and will damage kidneys further.

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5
Q

A NP finds ACEI on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

increase risk of hyperkalemia

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6
Q

A NP finds WARFARIN on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

Increase the risk of over-coagulation (INR>4).

Severe CKD and ESRD at risk for hemorrhagic complications.

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7
Q

A NP finds LITHIUM on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

Increase risk for kidney injury

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8
Q

A NP finds contrast dye on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

Injure kidneys

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9
Q

A NP finds potassium-sparing diuretics on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

increase risk for hyperkalemia

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10
Q

A NP finds sodium- phosphate (used of bowel prep) on the medication profile for a patient. A NP knows this will affects patients with CKD by

A

FDA 2019 WARNING

may cause sudden loss of kidney function as well as blood mineral disturbances.

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11
Q

Drugs that slow down drug clearance, will increase risk for drug overdose. Which drugs inhibit the CYP450 system?

A
  1. Macrolides
  2. Antifungals
  3. Phenytoin
  4. Cimetidine
  5. Citalopram
  6. Protease inhibitors (- inavir)
  7. Grapefruit
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12
Q

Your patient informs you that their favorite juice is grapefruit juice. What do you know as a NP about grapefruit juice and drug interactions?

A

Statins, erythromycin, CCB, antivirals, amiodarone, benzodiazepines, cisapride, carbamazepine, and buspirone

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13
Q

Your patient is on Digoxin. What do you monitor?

A

Digoxin level, potassium, calcium, magnesium, EKG, creatinine

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14
Q

Your patient is on Lithium. What do you monitor for?

A

Lithium levels, and TSH

Patient is at risk for developing hypothyroidism on medication.

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15
Q

Your patient is on H2 Antagonist. What are some safety issues you need to know?

A

Patients with kidney disease may experience mental changes.

Do not prescribe if the creatine clearance is <50mL/minutes

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16
Q

Your patient is on PPI. What are some safety issues you need to know? What can it cause with prolong use?

A 
Post-menopausal women are at risk for fractures. 
Can cause PNA
C-diff
Low Magnesium
Malabsorption of B12 and iron
Atrophic gastritis
Kidney disease
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17
Q

What drugs interact with PPIs?

A 
Warfarin
Diazepam
Carbamazepine
Phenytoin
Ketoconazole
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18
Q

Your patient is on Vitamin K Antagonist. What are some safety issues you need to know?

A

LOOK OUT FOR 4 G herbs. Make sure to ask about medications and herbs taken at home.

  1. garlic
  2. gingko
  3. ginseng
  4. ginger

Make sure to DC 7 days before surgery
Avoid Green leafy vegetables and mayonnaise

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19
Q

Your patient is on thiazolidinediones (TZDs) . What are some safety issues you need to know? BLACK BOX WARNING

A

BBW: Cause or exacerbate CHF. If the patient scores CLASS II or IV for the HF. DO NOT USE

Contraindications:
Hx of CHF, MI, STROKE, bladder cancer, DM-1, Eye disease, liver disease.

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20
Q

Your patient is on ACTOS. What symptoms would warrant the NP to discontinue this medication?

A

HF:

Dyspnea, weight gain, cough

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21
Q

Your patient is on atypical psychotic. What are some safety issues and educational topics you need to know?

A

Education that the medications will cause weight gain.
Can cause metabolic syndrome, DM2
Monitor for weight gain for the 1st 3 months

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22
Q

Your patient is on atypical psychotic. What will the NP monitor for?

A 
Weight gain by measuring the body mass index
Blood glucose
Hgb A1C
TSH
Lipids
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23
Q

Your patient is on atypical psychotic. Name 3 drugs. What is the BLACK BOX WARNING?

A
  1. risperidone
  2. olanzapine
  3. quetiapine

BBW: higher mortality rate in the elderly

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24
Q

What are the contraindications for bisphosphonates?

A

Bisphosphonates cause erosive esophagitis

Active GI disease such as GERD or PUD
CKD
Esophageal strictures or varies.

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25
Q

Your patient is on STAINS. What are some safety issues you need to know?

A

Do not mix with grapefruit juice. Drug-induced hepatitis,
With -AZOLE antifungals can cause rhabdo.
Chinese descent: increase risk for rhabdo especially taken niacin.

Increase Kinase levels

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26
Q

A patient is on a -statin. What s/s would be indicative of rhabdo?

A

muscle weakness, muscle pain, muscle tenderness, brown or dark red urine.

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27
Q

A patient is taking lincosamides. What to monitor for?

A

Cleocin

high risk for c-diff

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28
Q

Your pediatric patient is on an inhaled corticoid steroid. What are some safety issues you need to know?

A

Children: can cause adrenal insufficiency if on longer than 6 months
Target: High doses with children with low BMI
Monitor for growth retardations

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29
Q

What is some s/s of adrenal insufficiency?

A

Hypoglycemia, hypotension, altered mental status, weakness, Cushingoid features)

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30
Q

A patient is on systemic glucocorticoids? What would cause CAUTION and safety issues?

A

Patients with cataract, osteoporosis, skin changes (telangiectasia, easy bruising), weight gain high BP

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31
Q

A patient is on phenytoin? What would cause CAUTION and safety issues?

A

Monitor for toxicity- horizontal nystagmus, unsteady gait, WORSENS with slurred speech, lethargy, confusion, coma

Education patient on gingival hyperplasia

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32
Q

What are the BEERS CRITERIA used for ?

A

Provide guidance regarding medications that should be AVOIDED for patients over 65 y/o

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33
Q

According to the BEERS CRITERIA, what medications should be avoided for sleep in patient older than 65 y/o.

A

First generation antihistamines may cause dizziness which will lead to falls.

  1. diphenhydramine
  2. doxylamine
  3. chlorpheniramine
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34
Q

According to the BEERS CRITERIA, what antipsychotics should be avoided in patient older than 65 y/o.

A

quetiapine
clozapine (Clozaril)
pimavanserin

USE WITH CAUTION

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35
Q

According to the BEERS CRITERIA, what anticoagulation should be avoided in patient older than 65 y/o.

A

Rivaroxaban
Dabigatran

Why? higher risk for bleeding than warfarin and other direct oral anticoagulants.

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36
Q

According to the BEERS CRITERIA, what does tramadol put patient over than 65 y/o at risk for.

A

Hyponatremia from SIADH

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37
Q

According to the BEERS CRITERIA, what does Opioids put patient over than 65 y/o at risk for.

A

Severe respiratory depression with BENZO and gabapentinoids.

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38
Q

What is the second-third line of drug to treat heart failure with a reduced ejection fraction?

A

DIGOXIN

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39
Q

What is the therapeutic range for digoxin?

A

0.5-2.0

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40
Q

Which plants put a patient at risk for cardia glycosides poison?

A

foxglove, oleander, and lily of valley

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41
Q

What are the s/s of a digoxin overdose?

A

GI (nausea/vomiting)
Hyperkalemia
Brady-dysrhythmias (atrioventricular [AV] blocks)
Tachydysrhythmias (ventricular tachycardia/fibrillation)
Atrial tachycardia with 2:1 block
Confusion
Visual changes (yellowish-green–tinged color vision).

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42
Q

What is the antidote for digoxin overdose?

A

Digoxin-specific antibodies
IgG antidigoxin antibodies
Digibind
DigiFab

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43
Q

What do you treat antiphospholipid syndrome?

A

Warfarin
(Antiphospholipid syndrome: An autoimmune disorder in which the immune system mistakenly produces antibodies and attacks the normal proteins in the blood. This results in increased risk of blood clots in legs, kidneys, lungs and brain.)

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44
Q

The NP is dosing a patient for Warfarin. What do the NP know about initial dosing?

A

ONSET 24-72 hours BUT it will take 5-7 days to reach the therapeutic range, therefore you will need a bridging agent such as Lovenox SUBQ (CARDS MD initiates it).

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45
Q

FOR atrial fibrillation, DVT, stroke/CVA what is the INR range?

A

2.0 to 3.0 (ideal INR 2.5)

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46
Q

For mechanical mitral valves (lifelong anticoagulation), what is the goal INR?

A

2.5-3.5

ideal 3.0

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47
Q

A patient has mechanical prosthetic valve, what should the NP expect?

A

Dual therapy -Concurrent

ASA and Warfarin

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48
Q

A NP expect an increase in INR after …

A

The INR will increase 2 to 3 days after the first warfarin dose

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49
Q

A patient is on Warfarin therapy. What is the follow-up for Consistently Stable INR?

A

Check every 2 to 4 weeks up to every 12 weeks.

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50
Q

A patient is on Warfarin therapy. What is the follow-up for Single Out-of-Range INR?

A

If patient has stable INR and has a single out-of-range INR ≤0.5 below or above therapeutic INR (2–3), experts suggest continuing current warfarin dose.

Retest INR within 1 to 2 weeks.

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51
Q

A patient is on Warfarin therapy. What is the follow-up for INR <5 With No Significant Bleeding Risk?

A

Omit one dose
Reduce maintenance dose slightly
Re-check INR.

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52
Q

Your patient reports eating green leafy vegetables while on Warfarin. What will the NP expect on lab work?

A

High intake of vitamin K will reduce anticoagulant effect of warfarin (will decrease INR)

FOODS: kale, spinach, collards/mustard/beet greens, broccoli raab, Mayonnaise, canola oil, and soybean oil

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53
Q

What is other another name for Vitamin K?

A

phytonadione

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54
Q

How would a NP educate a patient on Warfarin about alcohol usage?

A

Avoid drinking or limit to no more than one or two servings occasionally

Increases risk of bleeding even if INR is in target range.

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55
Q

What is rare reaction to Warfarin?

A

Purple toes syndrome” (rare)

Skin necrosis located in subcutaneous fat, breasts, extremities, trunk (within first few days of receiving large doses of warfarin), bleeding

56
Q

Direct Oral Anticoagulants

  1. Direct thrombin inhibitors
  2. Direct factor Xa (FXa) inhibitors
A
  1. Direct thrombin inhibitors
    (dabigatran)
  2. Direct factor Xa (FXa) inhibitors
    (apixaban, rivaroxaban, betrixaban, edoxaban)
57
Q

What are the reversal agents for Dabigatran (Pradaxa)?

A

idarucizumab (Praxbind)

58
Q

What are the reversal agents for Rivaroxaban (Xarelto), and apixaban (Eliquis)?

A

andexanet alfa (Andexxa)

59
Q

There is no antidote for Plavix, but you can give …

A

Fresh frozen plasma or cryoprecipitate

60
Q

Patient is experiencing salicylate overdose. NP knows the wait time is …

A

After taking aspirin, it takes 4 days for the platelet function to return to normal

61
Q

Ketorolac (Toradol) cannot be used over ________ days.

A

5 days

62
Q

What treats dysmenorrhea?

A

Naproxen (Aleve, Naprosyn)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin)
Mefenamic acid (Ponstel)

63
Q

Gingko biloba, garlic, ginseng, fish oil, feverfew, Dong quai

What education should be given to the patient on this herbal therapy?

A

Increase bleeding risk, especially if taken in high doses

advise patient to stop taking approximately 7 days before surgery

64
Q

What is a consideration for dosing Warfarin to patient that are sensative to dose adjustments?

A

Asian patients may require lower starting and maintenance doses of warfarin.

Some genotypes require lower doses of warfarin (genetic testing is available)

Persons older than 60 years are more likely to have larger increases in INR (after dose is increased) compared with younger patients.

65
Q

A patient is allergic to sulfa medications. Which ones should be discontinued?

A

https://en.wikipedia.org/wiki/List_of_sulfonamides

66
Q

Thiazide Diuretics is contraindications

A

Lithium use and sulfa allergy

67
Q

Thiazide diuretics have many adverse effects. How can it affect a patient’s lipid panel?

A

Elevates cholesterol and low-density lipoprotein (LDL)

Careful if preexisting hyperlipidemia

68
Q

Why would a NP use a thiazide diuretic to treat Hypertension accompanied by osteopenia or osteoporosis?

A

Thiazide diuretics reduce calcium excretion by the kidneys and stimulate the osteoblasts. This helps build bone.

69
Q

Potassium-Sparing Diuretics BBW!!!

A

Triamterene and Amiloride

Black box warning: Hyperkalemia, which can be fatal; higher risk with renal impairment, diabetes, elderly, severely ill

70
Q

Mineralocorticoid Receptor Antagonists BBW and AE?

A

Spironolactone and Eplerenone

Black box warning: There is increased risk of both benign and malignant tumors.

Spironolactone adverse effects: Gynecomastia (13%) and hyperkalemia

71
Q

What are the Loop Diuretics BBW?

A

Black box warning: Excessive amounts of furosemide may lead to profound diuresis; medical supervision required, individualized dose schedule

72
Q

Can a patient on Lasix experience pancreatitis, jaundice, and rash while taking the medication?

A

YES, because they are adverse effects

73
Q

A diabetic patient starts a beta-blockers medication for migraine prophylaxis. What should her education include regarding diabetes and beta-blockers?

A

Blunts hypoglycemic response (warn diabetic patients to initially monitor blood sugars more often)

74
Q

A patient abruptly stopped taking their beta blocker. What should the NP look for?

A

sinus tachycardia, high BP. and angina

75
Q

What change in conditions should monitor in the elderly when starting them on a beta-blocker?

A

hypotension, depression, fatigue

76
Q

Direct Renin Inhibitors are _____________. What are the contraindications?

A 
Contraindications
Concomitant use of ACEI or ARBs, especially in diabetic patients (risk of kidney injury, hypotension, hyperkalemia)
angioneurotic angioedema 
pregnancy/breastfeeding
age <6 years
renal artery stenosis

Aliskiren (Tekturna), aliskiren/HCTZ (Tekturna HCT)

77
Q

What is Entresto? What are the indications?

A

CLASS: Neprilysin Inhibitors and Angiotensin II Receptor Blockers

NAME: Sacubitril and valsartan

USE: Adult HF (NYHA Class II-IV) and pediatric HF (age >1 year)

78
Q

Entresto BBW

A

Black box warning: Fetal toxicity; drugs that act on the renin–angiotensin system can cause injury or death to the developing fetus; if pregnancy detected, discontinue as soon as possible

79
Q

Entresto contraindications

A

history of angioedema, regardless of cause.

80
Q

Entresto adverse effects

A 
Hypotension
Hyperkalemia
Angioedema
Dizziness
Cough
81
Q

How does Alpha-Blockers (Alpha-1-Adrenergic Antagonists) work on BPH? -zosin

A

Relaxes smooth muscles on the bladder neck and the prostate and improves symptoms of benign prostatic hypertension (BPH)

82
Q

Alpha-Blockers can be used to treat BPH and HTN. There are only two drugs this class that can lower BP? Which are …

A

Terazosin (Hytrin): Can lower BP and treat BPH

Doxazosin (Cardura): Can lower BP and treat BPH

83
Q

Alpha-Blockers should not be use if the patient has ….

A

Do not give during cataract/glaucoma surgery will cause floppy iris syndrome.

84
Q

Tamsulosin (Flomax) is started. What education should be given to the patient about safety?

A

Tamsulosin (Flomax) on initial dose may cause a vasovagal response, bottoming out the BP.

Patients need to be warned that someone should be with them when initiating therapy.

Priapism

85
Q

T or F

Alpha-blockers are not first-line choice except for males with both hypertension and BPH.

A

False. It is first line

86
Q

When does Sudden Cardiac Death occur, in the United States?

A
  • More likely to occur in the morning between 7 a.m. and 9 a.m. (70% higher).
  • Day of the Week: Monday
  • Season: Winter
87
Q

A NP knows that a direct renin inhibitor such as Aliskiren, cannot be combined with _________________ and ___________.

A

ACEI and ARBS

-PRIL and -SARTAN

88
Q

What is the BBW for ACEI?

A

Black box warning: ACEIs can cause death/injury to the developing fetus.

These are not to be used during pregnancy, as these drugs damage the developing fetal renin-angiotensin system and can lead to death.

89
Q

Why would a NP order ACEI for hypertension with diabetes?

A

Renal protection

90
Q

A NP knows that the contraindications for ACEI and ARBS are?

A 
Pregnancy
Renal artery stenosis
Angioedema
Hyperkalemia (>5.5 mmol/L)
Hypersensitivity to the drug
91
Q

Aliskiren and sacubitril/valsartan cannot be given to patient with a history of angioedema. The NP needs to switch them to an ACEI. What is the wait time between going to an ACEI or switching from ACEI?

A

3 days

92
Q

True or False

Diabetics should avoid concomitant use of sacubitril/valsartan with aliskiren

A

True

93
Q

ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of what

A

Mild to Moderate kidney failure with HTN

Diabetics with HTN

94
Q

What is the first line of therapy for Heart failure patients with a reduced ejection fraction?

A

ACEIs are first-line therapy for HF with left ventricular dysfunction (or HFrEF).

95
Q

The NP has a patient on Captopril. What should be monitored for and why?

A

Order: CBC with DIFF

Captopril is associated with agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).

96
Q

Can a breastfeeding mother have an ACEI or ARB?

A

Captopril is associated with agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).

97
Q

What is the pathophysiology of the cough associated with ACEIs?

A

ACEI-induced cough and angioedema are caused by inhibition of the metabolism of bradykinin and kallikrein system, which are involved in the inflammatory process.

98
Q

A NP have a patient with high risk for AKI or hyperkalemia. The NP just started a hypertensive medication that acts of the RAAS. When is the follow up to check for kidney function?

A

Check kidney function 3 to 5 days after starting the drug.

99
Q

Calcium Channel Blockers (Calcium Antagonists) are used in the following conditions:

A 
Hypertension
Angina pectoris
Coronary artery spasms
Supraventricular dysrhythmias
Pulmonary hypertension
Hypertrophic cardiomyopathy
Raynaud’s phenomenon (first line)
100
Q

Dihydropyridines and Nondihydropyridines CCB are different because ____

A

Dihydropyridine (DHP) CCBs tend to be more potent vasodilators than non-dihydropyridine (non-DHP) agents, whereas the latter have more marked negative inotropic effects.

101
Q

A NP needs to prescribe a ABT to a patient that is on Verapamil. What ABT is contraindicated?

A

Do not mix with erythromycin and clarithromycin (drug interaction).

102
Q

A NP needs to prescribe a ABT to a patient that is on Verapamil. What ABT is contraindicated?

A

Do not mix with erythromycin and clarithromycin (drug interaction).

103
Q

Verapamil and Cardizem should not be given with which heart conditions?

A

2nd-3rd Heart Block
Bradycardia
Heart Failure with a reduced ejection fraction

104
Q

A patient develops pedal edema while on a CCB. What should be included in the care and education?

A

Pedal edema may occur with nifedipine and amlodipine because of vasodilation. If it bothers patient, reduce dose or take it later in the day. The pedal edema is positional and improves when laying down.

105
Q

TRUE or FALSE

Hypotension and bradycardia are the main symptoms of CCB poisoning

A

TRUE

106
Q

What ABT increase Warfin levels?

A

SULFA

107
Q

Capsaicin Crease can use to treat other two diseases

A

Trigeminal neuralgia and post hermetic neuralgia

108
Q

ASA irreversibly suppress platelet function for up to ______ days

A

7

109
Q

When to avoid NSAIDS?

A

In patients with CHF, GI bleeding, and kidney disease

110
Q

ST. JOHN WARTS activates the enzymatic pathways in the liver. This decrease in drug levels. A NP will believe the patient to be under-medicated. Which medication would cause this interaction with St. John’s warts?

A

Antiretrovirals
Contraceptives
Cyclosporine

SSRI and SSNI — will cause serotonin syndrome

111
Q

What drugs interact with macrolide?

A

Anticoagulant
Digoxin
Theophylline
Selected Stains

112
Q

What are the gram positive bacterias?

A

Strep
Staph
Enterococcus

113
Q

What is the contraindication for fluoroquinolones?

A

Less than 18
Pregnancy
Breastfeeding
Myasthenia gravis

114
Q

What are the contraindication for sulfonamide?

A

G6PD anemia
Newborns
Infants < 2 months

HIV patient watch for Steven-Johnson

115
Q

What eye concerns is associated with Digoxin?

A

Overmedication can cause
Yellow-to green
Blurred vision
Halos

116
Q

What are the vision change concern associated with the usage of ETU and linezolid?

A

Optic neuropathy

117
Q

A patient is on prolong use steroid use. What are some concerns pertaining to the patient eyes?

A

Cataracts
Glaucoma
Optic neuritis

118
Q

What vision changes can occur while taking fluoroquinolone?

A

Retinal detachment

119
Q

Patients taken ED medication can experience what visual changes?

A

Cataract
Blurred Vision
Ischemic optic neuropathy

120
Q

What vision changes does a person taking Accutane have to watch out for?

A

Decrease night vision

Cataract

121
Q

What vision changes does a person taking Topamax may experience?

A

Acute-angle-closure glaucoma
ICP
Mydriasis

122
Q

A person taking Plaquenil may experience what different eye changes

A

Neuropathy

Permanent loss of vision

123
Q

What is the vitamin D daily allowance?

A

32 oz milk for infants
Infants 400 IU
1-70. 600 IU
>70 800IU

124
Q

When do we avoid given tetracyclines?

A

Pregnancy and patient younger than 9 y/o

125
Q

A patient has s MRSA skin infection. How to treat

A

First line : Bactrim DS

Doxycycline, Minocycline, Clindamycin

126
Q

Patient comes in with a non-MRSA skin infection. How to treat?

A

Cephalexin and Dicloxacillin

127
Q

How to treat cystitis?

A

Augmentin

128
Q

How to treat kidney infection?

A

Cephalexin or Cefdinir

129
Q

Patient has otitis media or rhinosinitis. What are the first and second lines of treatment?

A
  1. Amoxicillin
  2. Augmentin

Depend if the patient is pediatric or adult

130
Q

How to treat UTI for patients allergic to sulf medication?

A

Cipro

131
Q

How to treat patient with travelers’ diarrhea

A

Cipro

132
Q

How to treat patients with anthrax ?

A

Cipro and Anthrax vaccine

133
Q

How to treat bacterial conjunctivitis ?

A

OCUflox

Quinolone drug

134
Q

What are the commonly use sulf medications

A 
HTZ, lasix
Sulfonylurea used in diabetes
COX2 inhibitors 
Dapsone
Microbid
Sulfasalazine
Silvadene
135
Q

A patient has a UTI. What are the contraindication for Batrim DS.

A 
G6PD anemia 
Newborns
Infants
younger than 2 months 
Pregnancy

Patients on Warfarin

FNP Review (9 decks)

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