Advanced Pharmacology - NP actual questions with 100% correct answers + detailed explanations

Highest Teratogenic medications

Antiepileptic drugs

Antimicrobials - Tetracyclines, fluoroquinolones

Vitamin A in large doses

Some anticoags

Hormonal meds such as DES

Non-medication examples - Alcohol & cocaine

Transdermal absorption in neonates and infants

Increased absorption

Infants have thin skin - higher blood flow

Increased risk for toxicity

Intramuscular absorption in neonates and infants

Neonate - Slow and erratic first few days of life

Infants - Increased absorption due to increased blood flow

Oral absorption in neonates and infants

Increased absorption of drugs absorbed in stomach

Decreased absorption in drugs absorbed in intestines

Delayed gastric emptying

Increased absorption of acid-labile drugs - Low gastric acidity for 24 hr after birth

Metabolism is markedly faster in children under age

2

What effects do the below meds have on children:

Glucocorticoids

Tetracyclines

Sulfonamides

Glucocorticoids - Growth supression

Tetracyclines - Discolored teeth

Sulfonamides - Kernicterus

Considerations when selecting medication treatment:

Cost

Guidelines

Availability

Interactions

Side Effects

Allergies

Hepatic & renal function

Need for monitoring

Special populations - Pregnant, nursing, older adults

What drugs cannot be refilled by phone:

Schedule 2

Opioids are prescribed for:

Moderate to severe pain

When should a pt be referred to a pain specialist?

Patients who take 120 mg per day of morphine milligram equivalents

DEA# consists of two letters and 7 numbers - the letters are:

M for NP

and letter

Schedule 1 drugs

Heroin, cocaine, cannibus

Schedule 2 drugs

Less than 15 MG of hydrocodone per dosage unit

Vicodin

cocaine

Methadone

Fentanyl

Oxycodone

adderall

ritalin

Schedule III medications

Less than 90 MG of codeine per unit

Tylenol w/ codeine

Ketamine

Anabolic steroid

Testosterone

Schedule IV medications

Xanax

Soma

Darvon

Darvocet

Valium

Ambien

Tramadol

Schedule V drugs

Less than 200 MG of codeine

Cough Preparations (Robitussin AC)

Lomotil

Lyrica

Motofen

Parepectolin

Which med should be avoided in African Americans?

ACEi

What is the most common non-statin medication and what class is it in?

Ezetimibe (Zetia)

Cholesterol absorption inhibitor

What class is niacin in?

Nicotinic acid - Treatment for high triglycerides and mildly lowers LDL

Alirocumab and Evolocumab are both meds for?

Lowering LDL

Human monoclonal antibody

Most expensive cholesterol med

Requires a SQ injection

Most adverse reactions

Lowers LDL by 43-64%

Adverse effects of furosemide

Ototoxicity, low electrolytes, hyperglycemia, hyperuricemia, reduction of HDL increase in LDL & cholesterol

What should be prescribed with loop diuretic to prevent electrolyte imbalace?

Potassium sparing diuretic

What are thiazide diuretics prescribed for?

Essential HTN

Edema

Mechanism of action of aldactone

Blocks aldosterone in the distal nephron

Retention of potassium and promotes excretion of sodium

Adverse effects of spironalactone

Gynecomastia

menstural irregularities

impotence

hirstutism

deepening of the voice

Hyperkalemia

Black box warning for Spironalactone

Tumorigenic in rats

Black box warning for Triamterene & Amiloride

Hyperkalemia which can be fatal

Actions of Angiotensin II

Vasoconstriction

Release of aldosterone

Alteration of cardiac and vascular structure- May cause hypertrophy & remodeling

Drugs that block RAAS such as (ACEi) should be avoided in:

Pregnancy

Examples of ACEi

Ends in -pril

ACEi can reduce the risk for what:

Cardiovascular mortality caused by HTN

Baseline data needed for ACEi

BP

Renal function

Monitoring needed for ACEi

Creatinine 2-4 wks after starting

Track BP

ARBs are approved for treatment of what

HF

Diabetic neuropathy

MI

Prevention of MI

Stroke

Mechanism of action of ARBs

Block angiotensin II

Dilation of arterioles and veins

What is an example of a direct renin inhibitor and what is it approved for?

Aliskren (Tekurna, Rasilez)

Approved for HTN

What should be avoided when taking a DRI

High fat meals

What are Calcium channel blockers used to treat

Angina, Essential HTN, Aflutter, AFIB, SVT

What is the most common adverse reaction of CCBs

Constipation**

dizziness, hypotension

AV block- complete or partial

Gingival hyperplasia

Chronic eczematous rash

Verapamil increases the plasma level of what med by 60%

Digoxin

Nifedipine cannot be used to treat what?

Dysrhythmias

Reflex tachycardia can occur with which CCB

Nifedipine

Potential adverse effects of hydralazine

Reflex tachy

Increase in blood volume - Na & H2O retention

Lupus like symptoms*

What is minoxidil used for and what is a side effect?

Severe HTN

Can cause excessive hair growth (hypertrichosis)

Primary (essential) HTN does not

have an identifiable cause

Initial therapy to treat HTN generally:

Thiazide diuretics

What HTN med should be avoided in pt's with heart failure?

CCB - Because they can cause decreased contractility, edema

What HTN meds should be avoided for pt's with diabetes:

Beta blockers - Masks signs of hypoglycemia

Thiazides

Lasix

Most HTN meds can interfere with what?

Sexual function

What is the drug of choice for HTN in pregnancy?

Labetalol

What drugs are used to treat HF?

Diuretics

RAAS inhibitors

B Blockers

How does digoxin effect the heart function?

Increases the contractility

Potential adverse effects of Digoxin

Visual disturbances

Yellow tinge

Anorexia, N, V

Fatigue

Potential drug interactions with digoxin

Thiazide diuretics, loop diuretics, ACEi, ARBs, CCB

Optimal rage for Digoxin

0.5-0.8 ng/ml

Black box warning for Quinidine

Increased mortality with pt's with AFIB, A Flutter

Black box warning for Mexilitine

Increased risk for mortality when used for non-life-threatening arrythmias

Black box warning for amiodarone

Liver injury

Lung damage- Pulm fibrosis, pneumonitis

Amiodarone can be increased by taking with what:

Grapefruit juice

CYP3A4

Amio can increase the drug levels if given with:

Atypical antipsychotics

Benzos

Cyclosporines

statins

warfarin

HMG-CoA inhibitors are:

Statins

How is metabolic syndrome diagnosed?

3 of the following 5:

1) Elevated waist circumference >40 men and >30 women

2) High TG

3) Low HDL

4) High fasting blood glucose

5) High blood pressure > 130/85

Adverse effects of statins

Muscle cramps (myopathy), rhabdo

Hepatotoxicity

What is a major drug interaction with Gemfibrozil?

Increases the levels of Warfarin

Fibrates are contraindicated in patients with:

Liver disease

Gall bladder disease

What is variant angina caused by:

coronary artery spasm

How to prevent nitro tolerance:

Use on intermittent schedules

Allow for at least 8 hour drug free times (overnight)

Target INR when on warfarin & what other lab should be taken

INR 2.5-3.5

PT should also be measured daily during first 5 days of treatment

What are some medications that increase the effects of Warfarin?

ASA and other salicylates

Sulfonamides

Tylenol

Amio

Azole antifungals

Black box warning for methadone

QT prolognation

Resp depression

Torsades

Conventional DMARDS used to treat RA

Methorexate

Hydroxychoroquine (Plaquenil)

Example of biologic DMARD used to treat RA

Enbrel

Baseline data for methotrexate

CXR

pulm

GI status

Baseline data for hydroxycholorquine

Eye exam

EKG

baseline labs