2025/26 | Pharmacology Advanced Final NR 565 |2024-2025 latest version|Comprehensive questions and verified answers/accurate solutions|Already graded A+

Who should receive Tdap vaccination?

Adults in close contact with infants healthcare workers

Contraindication for Tdap vaccine

Severe allergic reaction to previous dose, or hx of encephalopathy within 7 days of vaccine

Varicella vaccine contraindications

Hx of anaphylaxis with previous dose, allergy to gelatin or neomycin

Hepatitis B vaccine contraindications

Previous rxn to vaccine, allergy to yeast and neomycin

Examples of attenuated vaccines

measles, mumps, rubella, chickenpox, yellow fever, rotavirus

examples of live vaccines

MMR, varicella, rotavirus, influenza

examples of toxoid vaccines

Diphtheria, tetanus, pertussis,

Examples of inactive viral antigen vaccine

Poliovirus (SALK), Hep A, Hep B, influenza

What are the types of immunity?

active, passive, and herd

Define vaccine

suspension of organisms or fractions of organisms that induce immunity

Post exposure prophylaxis for Rabies

human rabies immunoglobulin + human diploid cell vaccine on days 0,3,7,14

Patient teaching after vaccination

Redness and swelling can occur at site, mild fever or fatigue

Who can receive attenuated influenza vaccine (Flumist)

individuals >2yo an d less than 50. non pregnant, and those who are not immunocompromised

Pantoprazole dosing

40 - 80 mg ORAL or IV Qday

Metronidazole (Flagyl) dosing

250 mg 4x day or 500mg BID for 7-14 days

Ondansetron (Zofran) dosing

-8/24mg po 30 minutes prior to chemo initiation

-8/16 mg po Q12h for 1/2 days after chemo administration

-TOP 200

Albuterol Sulfate (inhalation) dosage

2 inhalations

What labs are used to diagnose thyroid disease

TSH T3 T4

When should you recheck labs after starting levothyroxine

6-8 weeks until euthyroid state

signs and symptoms of hypothyroidism

Thin, dry hair

Thick, brittle nails

constipation

bradycardia

Goiter

PeriOrbital edema

cold intolerance

weight gain

signs and symptoms hyperthyroidism

1. heat intolerance (high heat production)

2. weight loss, increased appetite

3. hyperactivity

4. diarrhea

5. high reflexes

6. pretibial myxedema (Graves)

7. warm moist skin; fine hair

8. chest pain, palpitations, arrhythmias, increased β-adrenergic receptors

Treatment of thyroid storm

- Propylthiouracil (preferred) or methimazole

- iodine-potassium solutions

- glucocorticoids

- beta blockers

Result of not treating hypothyroidism during pregnancy

Permanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester.

Treatment of hyperthyroidism

- Radioactive iodine (I131) works by destroying the thyroid gland

- Surgery to remove all or part of the thyroid gland

- Lifelong thyroid hormone replacement will be needed

Levothyroxine interactions

anticoagulants

antacids

sucralfate

turnips, cabbage, strawberries, peaches, spinach, peas, radishes

how to diagnose diabetes

Elevation of blood glucose, as determined by one of three tests:

1) Random blood glucose concentration higher than 200 mg/dL

2) Fasting glucose concentration of 126 mg/dL on more than one occasion

3) Abnormal oral glucose tolerance test

A1C goal for diabetics

7% per ADA standards

A1C goal for older adults

7-8%

When treating diabetes when should insulin be considered

A1C greater than 10%

How often should A1C be rechecked

Every 3-4 months

What is the action of insulin

Transporting glucose through the cell membrane therefore lowering blood glucose

Pioglitazone (Actos) contraindications

Type 1 diabetes

Diabetic ketoacidosis

Hypersensitivity

Clinical evidence of active liver disease

Active bladder cancer

Diabetic drug classifications

GLP-1

TZD

DPP-4i

Sulfonylureas

SGLT2i

Which drug class should be considered for diabetes prior to insulin

It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated.

Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin

Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD)

Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting.

Carbohydrate to insulin ratio when calculating basal insulin

500 divided by TDD

Which diabetic medications come with concern of hypoglycemia

Insulin, meglitinides, sulfonylureas, amylin analogues

Who is at risk for Methylxanthines toxicity

Older Adults taking anticholinergics and beta agonists

Smokers

Step 1 therapy for asthma and COPD

Manage with a SABA (albuterol) as needed.

Asthma Step 1: Intermittent

SABA PRN

Asthma Step 2: Mild Persistent

-General Symptoms >2 times/week BUT <1 time/day; exacerbations may affect activity

-Night Symptoms >2 times/month

-Lung Function: FEV1 or PEF ≥80% predicted. PEF variability 20-30%

Asthma Step 3: Moderate Persistent

-General Symptoms: Daily symptoms. Daily use of inhaled SABA. Exacerbations ≥2 times/week; may last days.

-Night symptoms >1 time/week

-Lung Function: FEV1 or PEF >60% to <80% predicted. PEF variability >30%

Asthma Step 4: Severe Persistent

-General Symptoms: Continued symptoms. Limited physical activity. Frequent exacerbations.

-Night Symptoms: Frequent

-Lung Function: FEV1 or PEF <60% predicted. PEF variability >30%

SABAs

albuterol, levalbuterol, terbutaline

Benefits of SABA

Short acting relief of bronchospasm

Relieves asthma attacks

SABA patient teaching

Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed.

Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and clean the mouthpiece with water at least once a week.

Instruct patient to notify health care professional if there is no response to the usual dose or if contents of one canister are used in less than 2 wk. Asthma and treatment regimen should be re-evaluated and corticosteroids should be considered. Need for increased use to treat symptoms indicates decrease in asthma control and need to re-evaluate patient's therapy.

Importance of knowing how often to use SABA

Can be deadly if misuse

LABAs

Salmeterol

Formoterol

Oldaterol

Benefits to a LABA are?

Less frequent dosing and nocturnal protection

LABA use in COPD

Usually first line in combination with LAMA

Examples of inhaled corticosteroids

beclomethasone, budesonide, fluticasone

Benefits of inhaled corticosteroids

Decrease eosinophils/mast cells/T-lymphocytes

Inhibit transcription of inflammatory genes in airway epithelium

Reduce endothelial cell leak

Upregulate B2 receptor production

Reduce airway epithelial subbasement membrane thickening

Steroid use in asthma

Short course of oral when asthma attack occurs usually prednisone

When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor)

Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations.

How does nicotine work?

when it gets into the brain, it attaches to acetylcholine receptors and mimics the actions acetylcholine. It also activates areas of the brain that are involved in producing feelings and pleasure and reward.

Nicotine Replacement Therapy (NRT)

a form of medicine that delivers small amounts of nicotine to the body to help a person quit using tobacco

Nicotine replacement education

inhalers should not be used by clients with asthma, with the gum and loengers no eating or drinking 15 minutes prior to using and during, with the patch take off at night because can cause nightmares or sleep disturbances and teach patient not to use other nicotine products while using patch due to the stimulation of the CNS, the lozenges need to slowly dissolve for effectiveness and no more then 5 in a 6 hrs period

Wellbutrin Contraindications

caution in patients with a history of seizures, anorexia nervosa, cocaine use, and alcohol withdrawal and bupropion. SR should not be given with MAOI inhibitors

Bupropion (Wellbutrin) length of treatment

7-12 weeks

Drug resistant TB

resistant to at least one first-line anti-TB drug

Treatment of TB in pregnancy

2 mos: INH, RIF, EMB

7 mos: INH, RIF

Isoniazid (INH)

-antiTB

- take daily for 6-12 months and most likely with other meds too

-worked if 3 neg. sputum cultures, no temp.

- Liver toxicity (hepato) check liver fxn

- Don't take with alcohol (liver fxn remember?)

- Take on empty stomach

Examples of decongestants

Phenylephrine

Pseudoephedrine

Which drug class has no significant drug interactions

Expectorants

Examples of H2 receptor antagonists

Cimetidine

Ranitidine

Famotidine

Nizatidine

Which H2RA has the most drug interactions?

Cimetidine

PPI associated with what deficiency

Calcium

Magnesium

B12

Short term use of PPI increases risk of

Community Acquired PNA

How to treat moderate to severe GERD

Long-term maintenance therapy of PPI is recommended for severe. Moderate???

GERD treatment in older adults

Avoid long term PPI due to associated bone fracture and vitamin and mineral deficiency

Which cytoprotective agents can be given in pregnancy

Carafate

When to test for H. pylori

If on treatment and not getting better. Consider testing before prescribing H2 receptor antagonists/PPIs.

how to treat H. pylori

2 antibiotics, PPI, pepto. MOC. AOC

Lifestyle modification to support ulcer healing

5-6 small meals a day, stop smoking, avoid NSAIDs

Which antidiarrheal agent should not be used in children during or after chickenpox

Pepto-Bismol (Bismuth Subsalycitate)

Traveler's diarrhea

E. coli

Traveler's Diarrhea Treatment

Cipro

Ciproflaxin (Cipro) teaching in Travelers Diarrhea

Only start if symptoms are progressive and not getting better with pepto

What drug is associated with gray/black stool and black tongue

Pepto-Bismol (Bismouth Subsalicylate)

constipation lifestyle changes

regular exercise

increase fluids!!!

bowel habit training

Increase fiber

Risks of laxatives during pregnancy

Gastrointestinal stimulation can induce labor.

Constipation treatment in pregnancy

Lifestyle

-Try fiber (psyllium, methyl cellulose) with adequate fluids first

-docusate and PEG are used to prevent and treat

Constipation treatment in breastfeeding

Senna

How does psyllium work?

absorbs H2O into GI tract to increase bulk of stool

What happens when psyllium doesn't produce bowel movements

Can result in fecal impaction and obstruction

Abd pain should be assessed with no BM

Why is a diary important in treatment and diagnosis of IBS

Can identify triggers

how to treat gastroparesis

Prokinetic drug is best Reglan

black box warning reglan

tardive dyskinesia

Metronidazole education

-avoid ETOH during and 2 days after

-take on empty stomach

-dry mouth