N5334 Final Exam Questions With Verified Answers Latest Updated 2024 (GRADED A+)

Prescribing basics correct answers Prescribing is regulated by state BON Proper RX correct answers Providers name and address, Telephone DEA Pt name/DOB/Addres Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and signature. Drug Schedules: Most addictive to least correct answers 1: Heroin,LSD, MJ 2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl, adderall, ritalin 3: codeine, ketamine, testosterone 4: xanax, valium, soma, ambient, tramadol 5: antidiarrheal, antitussives, lomotil, lyrica Pharmicodyamics correct answers The effects of drug on the body. Receptors are large molecules usually proteins, that interact and mediate the action of drugs agonist correct answers produce receptor stimulation and a conformational change every time they bind. Do not need all available receptors to produce a maximum response Partial agonist correct answers drugs that have properties in b/w those of full agonist and antagonist. They bind to receptors but when they occupy the receptor sites, they stimulate only some of the receptors. antagonist correct answers drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation. The block action of drugs (ex. Narcan) Bioavailabity correct answers % of administered dosage of the drug that survives the first pass through the liver and reaches the blood stream half life correct answers Time required for the amount of a drug in the body to decline by 50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the body what the body does to the drug correct answers absorption, distribution, metabolism, excretion Distribution correct answers movement of absorbed drug in bodily fluids throughout the body to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse) Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs can pass) N5334 Final Exam Questions and Answers Latest Updated 2024 (A+ GRADED) Protein binding correct answers unbound drug is free which is active, crosses membrane. Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugs Metabolism correct answers take place in the liver mostly. Chemical change of a drug structure to: Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive until metabolized in the body into the active compound, ex: levodopa), increase or decrease toxicity CYP450 correct answers enzymes constitutes the most important of the phase I metabolizing enzymes (account for about 75% of drug metabolism in the liver) Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates rendering them more readily excretable Substrate correct answers an agent that is metabolized by an enzyme into a metabolite and product and eventually excreted Inhibitors correct answers compete with other drugs for a particular enzyme affecting the metabolism (decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating drug inducer correct answers competes with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drug excretion correct answers renal: passive glomerular filtration, active tubular secretion, tubular reabsorption, gi tract, lung, sweat and salivary, mammary genomics correct answers study of the complete set of genetic information present in a cell, an organism, or species pharmacogenetics correct answers the study of the influence of hereditary factors on the response of individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug response Pharmacogenetics tests correct answers Mentioned on drug labels can be classified as "test required," "test recommended," and "information only." Currently, four drugs are required to have pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab, maraviroc and dasatinib wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial dosing Carbamazepine and Asisans correct answers Initiating carbamazepine therapy in these patients (allele HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis (TEN) The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What are they? correct answers Molecular size, Lipid solubility, degree of ionization at tissue pH Why is epinephrine given with local anesthetics? correct answers Decreases local blood flow (decreased risk of bleeding) Delays systemic absorption of the anesthetic prolongs anesthesia reduces the risk of toxicity What is the most widely used local anesthetic? correct answers Lidocaine What is a possible fatal reaction to benzocaine correct answers Methemoglobinemia What is included in application guidelines for topical anesthetics correct answers avoid wrapping the site and heating the site, avoid application to open skin Which medication will not cause rebound headaches from overuse? correct answers propranolol (preventative) What is the best option for menstural migraine? correct answers low dose estrogen about 3 days prior to menses What food can trigger migraines? correct answers Hot dog d/t nitrates What medication is a Seratonin 1B1D receptor agonist? correct answers Sumatriptan Butterbur can help as prevention for migraine therapy. What side effect can occur? correct answers Liver damage What are the 3 main classes of opiod receptors? correct answers Mu kappa delta Which of the following will reserve he effects caused by opioid agonist? correct answers naloxone Which of the medications are used to treat OIC? correct answers Naloxegol, methylinaltrexone, lubiprostone Tolerance is defined as correct answers increased does of a med needed to obtain the same response Which medication is used for opioid abuse? correct answers Naltrexone Euphoria induced by morphine: correct answers An exaggerated sense of well-being caused by the activation of mu receptors Which medication is given nasally for migraines? correct answers Butorphanol Which of the following describes the mechanism of NSAIDs? correct answers Inhibition of the cyclo-oxygenase enzyme Second generation COX 2 inhibitors: correct answers Suppress inflammation and cause less risk for gastric ulceration than COX 1, increase risk for heart disease Which of the following medications should not be given with ASA? correct answers Glucocorticoids Which medication is given for acetaminophen overdose? correct answers Acetylcysteine What are non endocrine therapeutic uses for glucocorticoids? correct answers RA, SLE, IBS, Bursitis, OA, Gout, disorders of the eye What is the danger of prolonged use of glucocorticoids? correct answers adrenal insufficiency Methotrexate can cause fatal toxicities of: correct answers Bone marrow, liver, kidneys, lungs. Hemorrhagic enteritis and GI perforation Jane is on etanercept for RA. The NP knows correct answers Jane should be checked for TB yearly What is first line treatment for gout? correct answers Colchicine, indomethacin When would you initiate a Uriosuric Medication? correct answers more than 3 gout attacks per year Antiinflammatories correct answers inhibition of COX 1: protects against MI and stroke inhibition COX 2: surpasses inflammation, pain and protects against colorectal cancer (less GI bleeding) first generation NSAIDS correct answers inhibit COX 1 and COX2: treatment is for relief of mild to moderate pain, relief of cramps r/t dysmenorrhea (risk GI bleed and renal impairment) generation 2 NSAIDS correct answers only suppresses COX2, decreased risk for GI bleeding but impose risk for increased heart disease Aspirin correct answers Non-selective inhibitor of COX, therapeutic use analgesic, fever, mensural cramps, anti-inflammatory, Alzheimer disease. Risk for bleeding is too high. Increased secretion of acid and pepsin therefore ruins all the protective lining of the stomaching. Pt at risk: alcoholics, smoking, older people, or people who have had PUD. Risk of ASA is not advised in EMAIL ME: EMAIL ME: pt younger than 18 r/t Reyes syndrome, pregnancy because it cause ductus arteriosis, if given with Ibuprofen it can decrease effects of ASA. first generation non-ASA NSAIDS correct answers inhibit COX 1 and 2, given for RA and OA, no protection against MI or stroke. ex. Ibuprofen, alieve, diclophinac. Indicated for mild to moderate pain, antiinflammaroty and analgesic effects. risk of GI bleed Celebrex correct answers second generation non ASA nsaids, lower risk for GI but can still cause renal impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies. Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors. Acetaminophen correct answers Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr period. for overdose: acetylesistine. Can blunt immune response of vaccines glucocosteroids correct answers Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7 days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants. Therapeutic use: allergic condition, asthma and immune suppression. RA correct answers very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases. * First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline) Gout correct answers Monoarticular arthritis, d/o r/t kidney don't excrete enough uric acid. Only way to diagnosis is joint aspiration and look for the uric crystals Prevention is best Gout preventions correct answers Migraines correct answers trial and error of medication and triggers. start with over the counter and move to more aggressive over time. +2 a month, preventative medication is okay. Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasm Preventative: Beta blockers, antiseizure medications (depikote and topimax), tricyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur. cluster headaches correct answers intensely painful headaches that affect one side of the head and may be associated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutes prophylaxis tx with regular Headaches EMAIL ME: Depression tx correct answers SSRI, SNRI, Bupropion are first line treatments. Least side effects of any medications Mild/moderate depression or anxiety are okay to treat but anything else needs to be referred to a psychiatric NP tricyclic antidepressants correct answers Weigh gain, drowsiness, and terrible anticholinergic effects. beers list, Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. SSRIs correct answers Fluoxetine, paroxetine, sertraline, citalopram. effects don't start for several weeks (4-6 weeks) can cause weight gain, vivid dreams, bruxism, bleeding disorders, ED/sexual dysfunction, hyponatriemia, most can cause n/v that might go away. need to taper off these meds.