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Pharmacology Exam 2: Questions and Answers, Quizzes of Nursing

University of West London (UWL)Nursing

A comprehensive set of questions and answers covering various aspects of pharmacology, particularly focusing on medications used for treating seizures, depression, anxiety, and bipolar disorder. It also includes sections on antimicrobial resistance and antibiotic use. Valuable for students studying pharmacology, as it offers a structured approach to understanding key concepts and clinical applications of different drug classes.

Typology: Quizzes

2023/2024

Available from 12/13/2024

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615-PHARM EXAM 2 SUPER-DUPER Q&A 2024
615-PHARM EXAM 2 SUPER-DUPER Q&A 2024 100% PASS
1. Henry has recently started on carbamazepine to treat seizures. He comes to see you
and you note that while his carbamazepine levels had been in the therapeutic range,
they are now low. The possible cause for the low carbamazepine levels include:
Carbamazepine auto-induces metabolism, leading to lower levels despite good
compliance.
2. Carbamazepine has a Black Box Warning due to life-threatening:
Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
3. Long-term monitoring of patients who are taking carbamazepine includes:
Complete blood count every 3 to 4 months (can be a decrease in WBC &
platelets)
4. Six-year-old Felisha has recently been started on ethosuximide (Zarontin) for
seizures. She should be monitored for:
Blood dyscrasias, which are uncommon but possible
5. What should families be taught regarding seizure activity monitoring?
Prevention of seizures, patient safety, quality of life issues, reach acceptable goals for
treatment, & do not abruptly stop taking seizure meds
6. What electrolyte imbalance is associated with topiramate?
Decreased sodium bicarb leading to hyperchloremic metabolic acidosis
7. Lisa, who is overweight, recently started taking topiramate for seizures and at her
follow- up visit you note she has lost 4 kg. The appropriate action would be:
Reassure her that this is a normal side effect of topiramate and continue to monitor her
weight.
8. Travis’s seizures are well controlled on topiramate and he wants to start playing
baseball. Education for Travis regarding his topiramate includes:
He should monitor his temperature and ability to sweat in the heat while playing
9. Brandy is taking valproate (Depakote) for seizures and would like to get pregnant.
What advice would you give her?
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Partial preview of the text

Download Pharmacology Exam 2: Questions and Answers and more Quizzes Nursing in PDF only on Docsity!

615-PHARM EXAM 2 SUPER-DUPER Q&A 2024 100% PASS

  1. Henry has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance.
  2. Carbamazepine has a Black Box Warning due to life-threatening: Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
  3. Long-term monitoring of patients who are taking carbamazepine includes: Complete blood count every 3 to 4 months (can be a decrease in WBC & platelets)
  4. Six-year-old Felisha has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: Blood dyscrasias, which are uncommon but possible
  5. What should families be taught regarding seizure activity monitoring? Prevention of seizures, patient safety, quality of life issues, reach acceptable goals for treatment, & do not abruptly stop taking seizure meds
  6. What electrolyte imbalance is associated with topiramate? Decreased sodium bicarb leading to hyperchloremic metabolic acidosis
  7. Lisa, who is overweight, recently started taking topiramate for seizures and at her follow- up visit you note she has lost 4 kg. The appropriate action would be: Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.
  8. Travis’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Travis regarding his topiramate includes: He should monitor his temperature and ability to sweat in the heat while playing
  9. Brandy is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

Valproate is a known teratogen, but may be taken after the first trimester if necessary. Keppra is a better drug to be on until the second trimester, then she can go back to valproate.

  1. What category is valproate? Category X
  2. The tricyclic antidepressants should be prescribed cautiously in patients with: Heart disease
  3. A 64-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex), MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce, and symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment
  4. What are the precautions and contraindications for tricyclic antidepressants? Side effects are similar to anticholinergic activity such as dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, and mania. Caution in patients with cardiac disease (terminate ventricular fibrillation, decrease cardiac contractility, increase collateral blood circulation to ischemic heart muscles).
  5. Marla is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes: SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
  6. What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor? They can feel a bit of nausea, but this resolves in a week.
  7. Which of the following should not be taken with a selective serotonin reuptake inhibitor? Alcohol

Remember it is similar to anticholinergic side effects-“can’t see, can’t pee, can’t spit, can’t shit.”

  1. What are the side effects of SSRIs? N/V, H/A, light-headedness, dizziness, dry mouth, increased sweating, weight changes, exacerbation of anxiety, agitation, and sexual side effects. Side effects are generally minor.
  2. What are the side effects of SNRIs? (serotonin and norepinephrine reuptake inhibitor) H/A, somnolence, dizziness, insomnia, nervousness, nausea, dry mouth, constipation, abnormal ejaculations, anorexia/weight loss, and elevated BP at higher doses.
  3. What are the side effects of MOIs? Insomnia, anxiety, agitation are initial adverse reactions. Common side effects include dizziness, H/A, restlessness, and hypotension. Also, dry mouth, blurred vision, urinary retention and constipation
  4. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: Alprazolam (Xanax)
  5. What receptors do benzodiazepines act on? Enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA-A) receptors which results in a sedative hypnotic anxiolytics/anticonvulsant/muscle relaxer properties.
  6. Long-acting benzos are prescribed for? Treatment of anxiety
  7. Short and intermediate-acting benzos are prescribed for? Treatment of insomnia
  8. An appropriate drug to initially treat panic disorder is: Diazepam (Valium)
  9. Bernadette, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

Anorexiants may cause tolerance and should only be prescribed for 6 months

  1. Before prescribing phentermine to Bernadette, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to: The risk of serotonin syndrome
  2. Outside the brain phentermine releases norepi & epi causing what to break down? Fat cells to break down stored fat
  3. When prescribing phentermine what should you assess for? You must inquire if the patient is taking St. John’s Wort and or an SSRI as these things can increase the risk of serotonin syndrome (H/A, agitation, hyomania, mental confusion, hallucinations, & coma). Wait, there’s more…you also get autonomic effects like shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea, and somatic effects such as myoclonis, hyperreflexia, and tremor!
  4. Factors that place a patient at risk of developing an antimicrobial-resistant organism include: Inappropriate use of antimicrobials
  5. Infants and young children are at higher risk of developing antibiotic-resistant infections due to: The fact that children this age are more likely to be in daycare and exposed to pathogens from other children
  6. What must you instruct your patients do when taking an antibiotic? Counsel your patients that they need to take the entire antibiotic course for all of the days until the bottle is empty
  7. There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase- producing organisms
  1. Cindy was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her? Assess her for pseudomembranous colitis
  2. MEMORIZE: the American College of Cardiology and the American Heart Association’s guide to ABX prophylactic use for dental appointments. See below…
  3. According to the American College of Cardiology and the American Heart Association, what are the guidelines related to prophylactic antibiotics prior to a dental appointment? a. This is a very important question. This will be on your exam. If you go to the American Heart Association and look up the guideline, I would memorize this because these questions can be very tricky. b. Antibiotic prophylaxis with dental procedures is reasonable only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis including: i. Prosthetic cardiac valve or prosthetic material used in valve repair ii. Previous endocarditis iii. Congenital heart disease only in the following categories:
  4. Unrepaired cyanotic congenital heart disease including those with palliative shunts and conduits
  5. Completely repaired congenital heart disease with prosthetic material device, whether place by surgery or catheter intervention during the six months after the procedure
  6. Repaired congenital heart disease with residual effects at the site or adjacent to the site of a prosthetic patch or prosthetic device, which inhibit endothelialization
  7. Cardiac transplantation recipients with cardiac valvular disease c. Pay very close attention to those subtypes d. The treatment used for a dental appointment is amoxicillin orally two grams. In children it would be 50 milligrams per kilogram e. Dental Procedures and Infective Endocarditis In the past, patients with nearly every type of congenital heart defect needed to receive antibiotics one hour before dental procedures or operations on the mouth, throat, gastrointestinal genital, or urinary tract. However, in 2007 the American Heart Association simplified its recommendations. Today, antibiotics before dental procedures are only recommended for patients with the highest risk of IE, those who have:

i. A prosthetic heart valve or who have had a heart valve repaired with prosthetic material. ii. A history of endocarditis. iii. A heart transplant with abnormal heart valve function iv. Certain congenital heart defects including:

  1. Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits.
  2. A congenital heart defect that's been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
  3. Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic devices f. Key changes for patients with congenital heart defects Preventive antibiotics are no longer recommended for any other congenital heart disease than these: i. Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits. ii. A congenital heart defect that's been completely repaired with prosthetic material or a device for the first six months after the repair procedure. iii. Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device. g. Additionally, taking antibiotics just to prevent endocarditis is not recommended for patients who have procedures involving the reproductive, urinary or gastrointestinal tracts.
  4. Kristine had a small ventricle septal defect (VSD) repaired when she was 3 years old and has no residual cardiac problems. She is now 28 and is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and American Heart Association guidelines is: None, no antibiotic is required for dental procedures
  5. What patient teaching will you provide to a patient who is experiencing non- infectious diarrhea related to ABX administration? Patient will need to be assessed for C. diff colitis. Advise patient to increase their probiotic intake with yogurt to repopulate the gut flora

Tetracyclines can also cause microvassicular fatty liver, tinnitus, and can interfere with methotrexate by displacing it from various protein binding sites they can cause breathing complications such as anaphylactic shock in some individuals.

  1. What are the most common drug interactions with levofloxacin? Potential tendon damage, black box warning (pregnancy), caution with older population and cortical steroid use, and interaction with warfarin
  2. A patient is administered gentamicin and complains of sudden hearing loss. What should the NP do? The NP should immediately instruct the patient to stop the medication as there is a concern for ototoxicity
  3. Which medications interact with linezolid (a weak MAO inhibitor)? Should not be used with other MAOIs, tyramine rich foods such as pork, aged cheese, alcohol, smoked or pickled foods, or serotonergic drugs (all the good stuff). It should also not be given with pethidine or meperidine (Demerol) under any circumstance d/t risk of serotonin syndrome.
  4. What is the treatment of Lyme Disease? Doxycylcline 100 mg PO q12 hrs x days
  5. To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed: Pyridoxine (vitamin B 6 )
  6. Mary is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need an assessment of: Renal function
  7. When prescribing acyclovir, patients should be educated regarding the: Need to drink lots of fluids during treatment (need to flush the kidneys as this class of drug can be nephrotoxic)
  8. Michael has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include:

Starting oseltamivir within the first 48 hours of influenza symptoms

  1. What is rifampin ABX prescribed for? TB, leprosy, and legionella among others
  2. What are the adverse effects of isoniazid (INH)? Used as the first line agent for the prevention and treatment of both waiting and active TB. Adverse effects include hepatotoxicity and peripheral neuropathy.
  3. What are the main effects of doxycycline? GI upset including anorexia, N/V, & diarrhea. Advise patient to take with food to decrease GI irritation. Dermatologic side effects include photosensitivity, rashes, Stevens-Johnson Syndrome (serious), and toxic epidermal necrolysis.
  4. What is the difference between oral Vanco and parenteral Vanco? First of all, Vanco is a large hydrophilic molecule that partitions poorly across the GI mucosa with a short half-life (usually admin 2xday). Oral is given for the treatment of pseudomembranous colitis (c.diff) so it can reach the site of infection, usually the colon. Parenteral Vanco is given for the treatment of MRSA infections and due to its caustic properties it should be administered through a PICC or central line.
  5. What mechanism of action (MOA) of azithromycin? Azithromycin is a macrolide which inhibits bacterial protein biosynthesis preventing peptidyl transferase from adding to the growing peptide attached to the transfer RNA to the next amino acid. It also inhibits ribosomal translation.
  6. Which class of antibiotics block bacterial protein production? Bacteriostatic ABX limit growth of bacteria by interfering with bacterial protein production, DNA replication, or other aspects of cellular bacterial metabolism. This group includes tetracyclines, sulfonamides, spectinomycin, trimethoprim, chloramphenicol, macrolides, lincosamides, clindamycin, ethambutol, nitrofurantoin, novobiocin, tigecycline, and oxazolidinone.
  7. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: AST, ALT, alkaline phosphatase, and bilirubin