WGU D116 Advanced Pharmacology Codina Textbook MASTERY GUIDE 2025: 80 Expert-Curated Q&A with Detailed Rationales, Clinical Applications, and NCLEX-Aligned Case Studies

drugs that cause the most drug interactions (6)

-macrolides (erythromycin, clarithromycin, telithromycin)

-antifungals (ketoconazole, fluconazole, itraconazole)

-Cimetidine (tagamet)

-citalopram (celexa)

-protease inhibitors (saquinavir, indinavir, nelfinavir)

-antipsychotics (clozapine, olanzapine, quetiapine)

Drugs affected by kidney disease:

NSAIDs

reduction of renal blood flow will damage kidneys

affect kidneys: ACEIs -"pril"

higher risk of hyperkalemia

affect kidneys: Warfarin

higher incidence of overcoagulation (INR >4) severe CKD/ESRD at risk of hemorrhagic complications, needs more frequent monitoring

affects kidneys: Lithium

increase risk of kidney injury, monitor renal function closely

affects kidney: Contrast dyes

can injure kidneys

affects kidneys: Potassium-sparing diuretics

increased risk of hyperkalemia

affects kidney: oral sodium phosphate (to cleanse bowel before colonoscopies)

may cause sudden loss of kidney function (AKI) as well as blood mineral disturbances

drugs adversely affected by grapefruit

grapefruit affects the CYP450 system

-statins

-erythromycin

-calcium channel blockers -"pine" (nifedipine, nisoldipine)

-antivirals -"vir" (indinavir, saquinavir)

-amiodarone

-benzodiazepines (diazepam, triazolam)

- cispride

-carbamazepine

-buspirone

safety issues associated with:

H2 antagonist- "dine"

-famotidine (pepcid)

-cimetidine (tagamet)

-nizatidine (axid)

mental status changes with kidney disease

-avoid if kidney disease with creatinine <50ml/min

safety issues associated with:

Proton pump inhibitors

-Omeprazole (prilosec)

increased risk of fractures (postmenopausal women)

-pneumonia, cdiff

-hypomagnesemia, vitamine B12 and iron malabsorption

-atrophic gastritis, kidney disease

safety issues associated with:

vitamin K antagonist

-warfarin (coumadin)

interacts with "G" herbs: garlic, ginger, ginkgo, ginseng

-feverfew, green tea, fish oils

-DC 7 days before surgery

safety issues associated with:

glucocorticoids

cataracts, osteoporosis, skin changes, weight gain, high BP, emotional lability

safety issues associated with:

anticonvulsant

-phenytoin (dilantin)

earliest signs of toxicity (unsteady gait, horizontal nystagmus) severe, slurred speech, lethargy, confusion, coma

safety issues associated with:

Thiazolidinediones

-Pioglitazone (Actos)

boxed warning: cause CHF exacerbation in some pts

safety issues associated with:

atypical antipsychotics

-Risperidone (risperdal)

-olanzapine (zyprexa)

-quetiapine (seroquel)

high risk of weight gain, metabolic syndrome, type 2 diabetes (monitor weight every 3 months)

- boxed: higher mortality in elderly pts

safety issues associated with:

bisphosphonates

-Alendronate (fosamax)

-Risedronates (actonel)

erosive esophagitis (chest pain with eating)

- take alone on empty stomach with water, wait 30 min to lie down

safety issues associated with:

lincosamides

- cliindamycin (cleocin)

higher risk cdiff

safety issues associated with:

inhaled corticosteroids

adrenal insufficiency possible in children

safety issues associated with:

statins

-atorvastatin (lipitor)

-lovastatin (mevacor)

do not mix with grapefruit

-high dose zocor can cause rhabdomyolysis

cardiac glycosides

-Digoxine (lanoxine)

-narrow therapeutic range (0.5-2.0ng/ml)

-life-threatening bradycardia, heart block, vtach, vfib

-visual changes (yellow-green tinged color vison)

Thiazide diuretics

HCTZ, 1st line therapy in black pts

-do not combine with lithium (increase risk of toxicity)

-do not give if sulfa allergy

-elevate glucose, cholesterol and uric acid levels

-hypokalemia

-can reduce calcium excretion helps build bone

Angiotensin-converting enzyme (ACE) inhibitors

-"pril" they block conversion of angiotensin 1 to angiotensin 2 (potent vasoconstrictor)

-avoid in pregnancy due to fetus death or damage to renin-angiotensin system in fetus

-prefer to use with pt with HF, CKD, diabetes, MI

-can cause dry cough

Angiotensin receptos blockers (ARBs)

-blocks angiotensin 2 (less aldosterone) "sartan"

-avoid in pregnancy r/t renal artery stenosis

calcium channel blockers

2 types

-used to tx HTN, angina, coronary artery spasms, SVT, pulmonary HTN, raynauds phenomenon (1st line)

-hypotension/bradycardia signs of CCB poisoning

-dihydropyridines - target blood vessels and cause them to relax, making them effective in treating high BP (amlodipine) -"pine"

-can cause peripheral edema, headache, flushingg, lightheaded

-non-dihydropyridines- affect heart muscle and HR (diltiazem, verapamil)

-can cause reflex tachycardia, worsen cardiac output

beta blockers (beta-antagonist)

-tx HTN, HFrEF (carvedilol), post MI, angina, arrythmias, migraine prophylaxis

-adjunctive tx for hyperthyroidism/ thyrotoxicosis (decrease HR, palpitations, tachycardia, anxiety)

-adverse: blunts hypoglycemic response (warn diabetic pts to minitor CBG), exacerbation of raynaud syndrome

direct renin inhibitors

-blocks action of renin

- Aliskiren (tekturna)

-do not combine with ACE or ARB due to increase risk of kidney injury especially in diabetics

alpha blockers (alpha 1-adrenergic antagonist)

relaxes smooth muscles on the bladder neck and prostates and improves symptoms of BPH - "osin"

-Terazosin (hytrin) and Doxazosin (cardura) can also lower BP

-prozosin (minipress) is an alpha blocker for HTN not BPH can be used off label for PTSD nightmares/sleep dysfunction

-adverse: hypotension (elderly), dizziness, priapism (flomax), do not give during cataract/ glaucome sugery (floppy iris syndrome)

-give at nights due to hypotension

-flomax can cause vasovagal response have someone with pt when taking 1st dose

antibiotics can be bacteriostatic or bactericidal

-bactericidal- kill bacteria

-bacteriostatic- limit bacterial growth and replication allows immune system to clean infection

tetracyclines (broad spectrum bacteriostatic) -"cycline"

- doxycycline, minocycline, tetracycline (can decrease contraceptive pills effectiveness)

-tx aerobic gram + or - bacteria and atypical bacteria/pathogens

-do not use during pregnancy can cause neutral tube defects and maternal hepatotoxicity

-permanent discoloration of teeth (yellow-gray-brown) during last half of pregnancy

-avoid tetracycline within 4 hrs of antacid, iron, zinc, calcium, mag, dairy, multivitamins

-adverse: photosensitivity

macrolides (bacteriostatic) but can be bactericidal with high doses- "mycin"

-allergic rxns less common

-erythromycin has a motilin-like effects can be used for gastroparesis and can be used during pregnancy and lactation

-tx gram +, MSSA

-most safe to use during pregnancy except tellithromycin

cephalosporins (category B)

-1st generation: cephalexin (keflex)

-2nd generation: cefuroxime(ceftin), cefprozil (cefzil) cefaclor (ceclor)

-3rd generation: ceftriaxone (rocephin), cefixime (suprax), cefdinir (omnicef)

-allergic reaction are common especially if allergic to penicillin

penicillins - bactericidal and directly kill bacteria

-can be used in pregnancy and lacatation

adverse: steven johnson syndrome

fluroquinolones- bactericidal

-ciprofloxacin, levofloxacin

-reserve tx for severe infections except for ophthalmic solutions

-adverse: risk of achilles tendon rupture

-do not use in <18 yo and pregnant women r/t effects on growing cartilage

sulfonamides

bactrim- do not use in 1st trimester

- do not use of allergic to sulfa drugs

-look for low H&H and jaundice

-2nd most frequent cause of allergic reactions (penicillins and cephalosporins are the 1st)

lincosamides

-clindamycin- should be used with caution in pt taking neuromuscular blocking agents

antihistamine (histamine antagonist or H1 blocker)

-diphenhydramine (benadryl), loratadine (claritin), cetirizine (zyrtec), fexofenadine (allegra) doxylamine (unisom) chlorpheniramine (chlortrimeton)

-avoid in elderly can use loratadine (claritin) due to decrease sedation

antitussives

-dextromethorphan (robitussin, delsym) can increase risk of serotonin syndrome

-benzonatate (tessalon) do not use <10 r/t sedating

mucolytics

guaifenesin (decongestant) should be avoided with HTN and CAD, angina, MI

-do not mix with other stimulants r/t heart palpitations, tremors, anxiety

glucocorticoids (steriods)

oral or systemic are adjunct tx for RA, lupus, anaphylaxis or septic shock

drugs that require eye exam

-digoxine (yellow-green vision, blured, halos)

-ethambutol and linezoid (optic neuropathy)

-corticosteroids (cataracts, glaucoma)

-fluroquinolones (retinal detachment)

-phosphodieasterase 5 inhibitors (cataracts, blurred vision)

-isotretinoin (decrease night vision)

-topiramate

-hydroxychloroquine

theophylline drug interations

level 5-15 mcg/ml

- drug interactions: cimetidine, alprazolam, macrolides, fluvoxamine

-disorders worsen with stimulants

-suspect toxicity with persistent vomiting

common herbal supplements

-echinachia (purple coneflower) - shorten cold/fly sx

-avoid if allergic to ragweed or autoimmune disease

feverfew or butterbur

migraine headaches

cinnamon

improves blood sugar and cholesterol

glucosamine (with/without chondroitin)

osteoarthritis

ginkgo biloba

dementia, memory problems, tinnitus

-affect blood clotting, stop 2 wks before surgery

-NSAIDS increase risk of bleeding

natural progesterone creams or sublingual capsules (Mexican wild yam or soybeans)

premenstrual symtoms and menopausal symptoms (hot flashes) no research on safety with long term

isoflavones (soybeans)

estrogen life effects

saw palmetto

urinary symptoms of BPH

kava kava, valerian root

anxiety and insomnia, do not mix of CNS drugs r/t sedative effects

st john wort

mild depression do not use with SSRI, sumatriptan, HIV protease inhibitors (indinavir)

turmeric

Alzheimer's disease, arthritis, cancer

fish/ krill oil, omega 3 oil

heart disease, high cholesterol, arthritis, joint pain reduces inflammation

pharmacogenomics is the study of

how genes affect the ability to respond to meds

pharmacokinetics is the study of

how a med is metabolized in a person

which of the following best describes the term half-life

the time it takes for a med to decrease its concentration by 50%

which of the following best describes minimum inhibitory concentration

lowest concentration of an antibiotic necessary to inhibit bacterial growth

which of the following best describes the concept of the area under the curve (AUC) it is a measure of:

the bioavailability of a med

which of the following best describes the concept of bioavailability

way a med is absorbed and used by the body

which of the following is/are main organs of biotransformation

liver

which of the following best describes the concert of 1st pass metabolism

med admin orally must first be metabolized in the liver

which following best describes a CYP450 inducer

a med that increases the clearance of other meds

which of the following best describes a CYP450 inhibitor

a med that decreases the clearance of other meds

which of the following statements best describes why prescribing in elderly pt must be undertaken cautiously

renal function decreases with age, so doses often have to be modified

a male pt presents with cough for several wks, denies ShOB or chest pain, newly dx HTN, physical exam lung fields are clear without retraction, which is likely cause of sx

enalapril

male pt presents with intermittent heart palpitation few days, report sx worsen at night and states "it feels like my heart is fluttering" denies use of illicit or recreational drugs, does not drink caffeine,review of med list reveals diltiazem, chlorthalidone, tamsulosin, trazodone. quick review of pt notes indicates that he was seen few days ago for upper resp tract infection and was given clarithromycin, on physical exam vitals signs are stable except for HR 112, which is the best next step

perform an EKG

male pt taking warfarin for afib calls office b/c he has nosebleeds since day before, also reports he cut his leg and bleeding has not stopped, these symptoms suggest

the INR is likely elevated and should be rechecked

57 yo black male present follow up of BP, it was elevated at 2 last visit, instructed to monitor at home, 140-145 and 95-100 consistently, BP 142/90 HR 82 today, past medical hx of COPD which is most appropriate initial intervention

chlorthalidone 25 mg once dailly and reeval in 3 months

which of the following statements best describes 1st pass metabolism

when an oral drug is swallowed it goes through small intestine, enter potal circulation of liver where it is metabolized before it is released to general circulation

68 yo M of hispanic descent has recently been discharged from the hospital with a dx of stroke secondary to VTE, DVT, type 2 diabetes, his meds are listed on discharge note as warfarin 5mg every mon/wed/fri/sunday, metformin 1g twice a day, aspirin 325mg daily, which of the following is the correct INR values

2.0 - 3.0

which of the following statement is most true

pharmacogenomics studies how variations in genes can affect drug metabolism

an elderly pt with a hx of severe mitral regurgitation has sx for placement of valve, which is correct INR value

2.5-3.5

which is adverse effect of Non dihydropyridine calcium channel blocker

constipation

which of the following best reflects how to monitor a med with narrow therapeutic index

levothyroxine monitor TSH

81 yo M c/o knee/ shoulder pain, long hx of osteroarthritis, has been taking OTC naproxen with min relief, past medical hx HTN, CAD, afib, MI, imaging normal except for degenerative joint disease, which tx of most appropriate

acetaminophen 500mg every 4-6 hrs PRN

77 yoF follow up echocardiogram, increased ShOB and pedal edema, LVEF 38% which is most appro

valsartan and carvedilol

15 yoF with acne, using OTC products no success, multiple open/closed comedones on face/forehead/chest, which is best tx

topical azelaic acid

male pt with worsening skin infection on forearm has been on cephalexin for 5 days with no improvement, pt reports aspirin and sulfa allergy, culture MRSA +, which is best tx

clindamycin

75 yo F with dysuria, past medical hx of HTN, afib, depression, anxiety, osteoartritis, current meds paroxetine, warfarin, lisinopril, HCTZ, tylenol, she is afebrile, urine shows large leukocytes, nitrates, trace blood, culture with sensitvity is sent to lab, which is best empiric tx

nitrofurantoin