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146 Cards in this Set
- Front
- Back
Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John’s Wort due to: |
The risk of serotonin syndrome |
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Caution when prescribing phentermine to an actively drinking alcoholic should be taken b/c it can cause: |
Depression, paranoia, or psychosis |
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Caution when prescribing phentermine to a pt with a hx of alcohol or drug dependence should be taken b/c there is a risk of: |
Cross-tolerance |
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Use of phentermine should be limited to how many months? |
6 months |
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phentermine is contraindicated in pts who abuse cocaine, methamphetamine, or phenylcyclidine b/c |
potential for excessive adrenergic stimulation |
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What is the length of time anorexiants should be prescribed? |
6 months |
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What is rectal diazepam (Diastat) used to treat |
refractory seizures in pts 2 yrs and older |
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What are the symptoms of phenytoin hypersensitivity syndrome |
fever, skin rash, and lymphadenopathy |
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When does phenytoin hypersensitivity syndrome usually occur? |
3-8 weeks of treatment |
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what unique metabolism ability does Carbamazepine have? |
auto-metabolism |
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Dwayne 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 in spite of good compliance |
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What is the Black Box Warning of carbamazepine? |
Regarding serious dermatological reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis) and the risk of developing aplastic anemia, thrombocytopenia and agranulocytosis |
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Carbamazepine has a Black Box warning due to life-threatening: |
Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis |
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What blood values should be monitored with carbamazepine? |
CBC, liver fx, TSH and serum level of the drug |
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long term monitoring of pts who are taking carbamazepine includes, CBC every ____ months |
3-4 |
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Carbamazepine (Tegretol) exerts it effect by depressing transmission in the |
nucleus ventralis anterior of the thalamus |
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the nucleus ventralis anterior of the thalamus is the area associated with |
spread of seizure discharge |
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carbamazepine is absorbed in the |
stomach |
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What's the most common adverse effect of ethosuximide (Zarontin)?
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GI distress (can be relieved taking it with food or milk) |
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Prior to treatment with ethosuximide (Zarontin), what labs should be done? |
CBC and liver fx |
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during treatment with ethosuximide (Zarontin), what labs should be done? |
serum med level, liver panel, renal panel, and hematological studies |
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Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be: |
Assess for suicidal ideation |
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Monitoring of a patient's seizures while on gabapentin to treat seizures includes: |
Recording seizure frequency, duration, and severity |
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How will you monitor patients for suicidal ideations when prescribing central nervous system medications? |
Monitor for emergence or worsening of depression, suicidal thoughts, or changes in behavior. |
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Topiramate will cause weight loss. What patient teaching will you provide? |
To monitor weight frequently and report any changes -has the side effect of anorexia |
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What should families be taught regarding the monitoring of seizure activity |
-Monitor frequency, duration, and severity - You should know that you may continue to have seizures during your treatment -You may need to avoid activities such as swimming, driving, and climbing so that you will not harm yourself or others if you lose consciousness during a seizure |
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What electrolyte imbalance is noted with the administration of topiramate? |
Decreased serum bicarbonate concentrations |
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Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: |
Reassure her that this is a normal side effect of topiramate and continue to monitor her weight |
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Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes |
He should monitor his temperature and ability to sweat in the heat while playing |
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Why doesn't levetiracetam interact with other meds |
mostly unbound and does not use CYP450 enzymes for metabolism, thereby decreasing the likelihood |
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Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her to not abruptly discontinue levetiracetam due to risk for
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withdrawal seizures |
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Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: |
Ruling out a hypersensitivity reaction that may lead to multi-organ failure |
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Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause: |
Reduced lamotrigine levels, requiring doubling the dose of lamotrigine |
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What is the pregnancy category for valproate? |
D |
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Valoroate should not be administered during pregnancy especially during the 1st trimester d/t risk of |
spina bifida |
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Most significant risk while taking tricyclic antidepressants is |
cardiac conduction disorder |
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Conduction disorders caused by tricyclic antidepressants include:
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depolarization leading to prolonged QRS, PR/QT
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Caution should be taken with TCA use in pts with glaucoma, prostatic hypertrophy, and urinary incontinence b/c of the
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acetycholine blocking effect
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TCA is pregnancy category
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C
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What are the cautions and contraindications with Phenelzine (Nardil)?
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Liver or kidney disease, hypersensitivity,CHF, arterioschlerotic disease, and over age 60
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Phenelzine (Nardil) is a pregnancy category
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C
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Phenelzine (Nardil) should not be prescribed to impulsive or cognitively impaired pts b/c
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they may be unable to follow instructions such as dietary restrictions
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MAOIs prevents breakdown of
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Tyramine
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The inhibition of metabolism of norepinephrine by MAOI's increases the change of
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hypertensive crisis
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MAOI's are indicated for
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treatment resistant unipolar depression, panic disorder, and atypical depression associated with borderline personality disorder
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How is Phenelzine (Nardil) used to treat recalcitrant depression?
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They irreversiblyinactivate the enzymes that metabolize norepinephrine, serotonin, and dopamine,thereby increasing their bioavailability
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What are the symptoms of hypertensive crisis?
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HA, heart palpitations,stiff or sore neck, chest tightness, tachycardia, sweating, and dilated pupils
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How long does it take for selective serotoninreuptake inhibitors to produce an effect in patients with depression?
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3-4 weeks
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all of the serotonin-norepinephrine reuptake inhibitors are administered for what disorders
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depression with lack of motivation, major depressive disorder, and bipolar mood disorder
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names of drugs in the serotonin-norepinephrine reuptake inhibitors class
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venlafaxine (effexor), duloxetine (Cymbalta), and Desvenlafaxine (Pristiq)
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What are the symptoms of EPS
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akathisia, dystonia, psuedoparkinsonism, dyskinesia,
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Measures the presence and severity of EPS
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abnormal involuntary movement scale
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Jake, a 45-year-old patient with schizophrenia, was recentlyhospitalized for acute psychosis due to medication noncompliance. He wastreated with IM long-acting haloperidol. Besides monitoring his schizophreniasymptoms, the patient should be assessed by his primary care provider:
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With the Abnormal Involuntary Movement Scale(AIMS) for EPS symptoms
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Anticholinergic agents, such as benztropine(Cogentin), may be given with a phenothiazine to:
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Reduce the chance of tardive dyskinesia
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When administeringolanzapine (Zyprexa) what should the nurse practitioner monitor?
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-metabolic syndrome (abdobesity, HTN, high cholesterol levels, and insulin resistance) d/t weight gain
-increased risk for DM |
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What are the adverse effects of risperidone?
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Seizures,weight gain, diabetes, hyperprolactinemia, dizziness, orthostatic hypotension,tachycardia, sleep disturbance, constipation, and rhinitis.
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How is the dosing increased with risperidone?
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initial dose: 1mg BID,increase every 24 hr by 1 mg per dose to target dose of 4-8mg per day
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Which benzodiazepam has the greatest risk fordeveloping dependence?
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Alprazolam (Xanax) andlorazepam (Ativan)
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Patients should be instructed regarding the rapid onset of zolpidem(Ambien) because:
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Zolpidem should be taken just before going tobed
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Why is buspirone (Buspar) and an SSRI combined?
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Combined intreatment-resistant depression b/c of the combined serotonergic mechanisms,that is, postsynaptic reuptake inhibition and receptor agonism.
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What type of diet is recommended with theadministration of lithium?
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Diet with adequate saltintake and to stay hydrated
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Tom is taking lithium for bipolar disorder. He should be taught what about his diet
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Eat a diet with consistent levels of salt(sodium)
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valproate is what pregnancy category
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D
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Cynthia is taking valproate (Depakote) for seizures and would liketo get pregnant. What advice would you give her?
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Valproate is a known teratogen, but may be takenafter the first trimester if necessary
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Kirk sprained his ankle and is asking for pain medication for hismild-to-moderate pain. The appropriate first line medication would be:
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ibuprofen
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Monitoring for a child on methylphenidate forADHD includes
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ADHD symptoms, Routine height and weight checks, and Amount of methylphenidate being used
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When prescribing Adderall (amphetamine and dextroamphetamine) toadults with ADHD the nurse practitioner will need to monitor:
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BP
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What is the most commonadverse effect when prescribing calcium carbonate antacids?
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constipation
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The ____ scale measures the presence and severity of EPS.
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The Abnormal Involuntary Movement Scale (AIMS)
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Extrapyramidal symptoms (EPSs), can be problematic for pts receiving what 2 classes/types of meds.
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dopamine-blocking agents
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EPS symptoms include:
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akathisia, dystonia, psuedoparkinsonism, anddyskinesia
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Jake, a45-year-old patient with schizophrenia, was recently hospitalized for acutepsychosis due to medication noncompliance. He was treated with IM long-actinghaloperidol. Besides monitoring his schizophrenia symptoms, the patient shouldbe assessed by his primary care provider using the:
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the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms
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Benztropinebelongs to a class of medication called
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anticholinergics
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There is a balance between what two types ofneurotransmitters in the body?
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dopamine and acetylcholine
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Antipsychotic meds artificially reduce dopamine levelswhich automatically shifts the level of acetylcholine as being _____in the body
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higher
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Anticholinergic agents, such as benztropine (Cogentin), may begiven with a phenothiazine to:
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Reduce the chance of tardive dyskinesia
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Beforestarting a patient on any of the atypical antipsychotics, which includeolanzapine, patient’s should be assessed for
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waistcircumference, body mass index (BMI), blood pressure, fasting plasma glucose,and lipid profile.
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Adverseeffects of risperidone include:
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orthostatichypotension, bradykinesia, akathisia, agitation and elevation of prolactinlevels
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Which benzodiazepam has the greatest risk for developing dependence?
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xanax (alprazolam)
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In choosing a benzodiazepam to treat anxiety the prescriber needsto be aware of the possibility of dependence. The benzodiazepam with thegreatest likelihood of rapidly developing dependence is:
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xanax (alprazolam)
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Temazepam should not be used more than ____ a week for less than _____.
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three times; 3 months
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Patients should be instructed regarding the rapid onset of zolpidem(Ambien) because:
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Zolpidem should be taken just before going to bed
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Why is buspirone (Buspar)and an SSRI combined?
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To treat resistantdepression
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What type of diet is recommended with theadministration of lithium?
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consistent levels of salt and increased fluids
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One major drug used to treat bipolar disease is lithium. Becauselithium has a narrow therapeutic range, it is important to recognizesymptoms of toxicity, such as:
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Drowsiness and nausea
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Can valproatebe administered in the first trimester of pregnancy? and what category is it?
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it should be restricted to cases in which the womans life would beendangered without them and then only beyond the first trimester ; D
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Cynthia is taking valproate (Depakote) for seizures and would liketo get pregnant. What advice would you give her?
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Valproate is a known teratogen, but may be takenafter the first trimester if necessary
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Kirk sprained his ankle and is asking for pain medication for hismild-to-moderate pain. The appropriate first line medication would be:
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Ibu (Advil)
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What is the most commonadverse effect when prescribing calcium carbonate antacids?
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constipation
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Many patientsself-medicate with antacids. Which patients should be counseled to not takecalcium carbonate antacids without discussing with their provider or apharmacist first?
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patients with kidney stones
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Calcium-basedantacids should not be administered with of food containing large amounts of what two acids?
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oxalicacid and phyticacids
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Takingcalcium-based antacids with foods that contain phosphorous (dairy products) maylead to
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milk-alkalisyndrome
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Patients taking antacids should be educated that these drugs should be separated from other medications by __ hour
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one
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Loperamidebinds with the ___ receptors of the intestinal wall leading to slowedgastric motility
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opiate
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Kelly has diarrhea and is wondering if she can take loperamide(Imodium) for the diarrhea. Loperamide:
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Slows gastric motility and reduces fluid andelectrolyte loss from diarrhea
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Josie is a 5 year old who presents to the clinic with a 48-hourhistory of nausea, vomiting, and some diarrhea. She is unable to keep fluidsdown and her weight is 4 pounds less than her last recorded weight. Besides IVfluids, her exam warrants the use of an antinausea medication. Which of thefollowing would be the appropriate drug to order for Josie?
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Ondansetron (Zofran)
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Patients who are on chronic long-term proton pump inhibitor therapyrequire monitoring for:
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Iron deficiency anemia, vitamin B12 and calciumdeficiency
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Patrick is a 10 year old who presents with constipation. Along withdiet changes, a laxative is ordered to provide more rapid relief ofconstipation. An appropriate choice of medication for a 10 year old would be:
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PEG 3350 (Miralax)
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Mainadverse effect of bismuth subsalicylate is
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reboundconstipation
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Bismuth subsalicylate may lead to toxicity if taken with:
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Aspirin
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Bismuth subsalicylate is contraindicated in children with_____ illness
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flu-like
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Bismuth subsalicylate has antimicrobial effects against ______ and ______.
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bacterial and viral enteropathogens
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Hannah will be traveling to Mexico with herchurch group over Spring Break to build houses. She is concerned she maydevelop traveler's diarrhea. Advice includes normal food and waterprecautions as well as
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Bismuth subsalicylate with each meal and bedtime
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What lab values should be monitored with long-term administration ofproton pump inhibitors?
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Iron, Vitamin B12 and calcium
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Why is osteoporosis a risk when taking omeprazole?
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Iron, Vitamin B12 and calcium all need an acidic environment foroptimal absorption.
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Sadie is a 72year old who takes omeprazole for her chronic GERD. Chronic long-termomeprazole use places her at increased risk for:
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Osteoporosis
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What is the most actinglaxative?
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Sulfate salts
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How does metoclopramide (Reglan) improveGERD?
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Increases lower esophagealsphincter (LES) tone.
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Antacids treat GERD by:
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Increasing gastric pH
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Infants with reflux are initially treated with:
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Anti-reflux maneuvers (elevate head of bed)
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When treating patients using the “Step-Down” approach the patientwith GERD is started on ____ first.
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Proton pump inhibitors
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If sx are relieved for __ wks using the step-down approach, after the first step, then step down to a ____ to control sx
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4; H2RA
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If sx are not relieved after the first step of the step down approach, step 2 should be initiated. Step 2 is:
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increasing PPI to BID x 4-8 weeks
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If sx are relieved for __ wks using the step-down approach, after the 2nd step, then step back up to _____ therapy which is ___ ____ and reassess in _______ mo.
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step 1; PPI QD: 6-12
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If sx are not relieved after using step 2 of the step-down approach:
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refer to gastroenterologist
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Step one of the step-up process is:
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lifestyle modification and antacids
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if sx relieved after step 1 of the step up process
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continue with lifestyle modifications and antacids prn
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If sx unrelieved after step 1 of the step-up process proceed to step 2 which is:
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H2RAs and continue lifestyle modifications x 4-8 wks.
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if sx relieved with step 2 of the step up process then
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continue for 8-12 wks and then attempt reduction or w/d of H2RA.
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if sx relieved with step 2 of the step up process and tx was continude for 8-12 wks and then attempt reduction or w/d of H2RA and sx returned then
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step 2 with continuous H2RA therapy
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if sx are unrelieved with step 2 of the step up process then proceed to step 3 which is
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change to PPI x 4-8 wks
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if sx relieved by step 3 of the step up process then
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trial step down to H2RA
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if sx return by trial step down to H2RA (relief following step 3) then ________. Pt should be reassessed in _ to _ mo and attempted to wean.
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return to PPI and continue even if sx are relieved eventually; 6-12
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If sx are not relieved by step 3 of the step up approach then refer to
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gastroenterologist
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Which bone is likely to befractured with long-term proton pump inhibitor therapy?
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hip
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What is the first line of therapy of triple therapy for peptic ulcer disease with positive H. pylori?
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PPI BID, clarithromycin 500mg BID or Metronidazole 500mg BID, and Amox 1g BID x 10-14 d
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What is the first line of therapy of triple therapy for peptic ulcer disease with positive H. pylori for pts allergic to PCN?
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PPI BID, clarithromycin 500mg BID, and Metronidazole 500mg BID x 7-14 d
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What is the second line of therapy for pts that fail the first line for peptic ulcer disease with positive H. pylori?
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PPI BID or Ranitidine 150mg BID, metronidazole 250mg QID, Tetracycline 500mg QID, and bismuth subsalicylate 525mg QID x 10-14 d
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what is the levoflaxacin based triple therapy for second line therapy or rescue therapy for peptic ulcer disease with positive H. pylori?
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PPI BID, levofloxacin 250-500mg BID and amox 1gm BID
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Treatment failure in patients with peptic ulcer disease associatedwith H. pylori may be due to:
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Antimicrobial resistance
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Henry presents to clinic with a significantly swollen painful greattoe and is diagnosed with gout. Of the following, which would be the besttreatment for Henry?
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Low-dose colchicine
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Whatlab values should be monitored with gout?
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uric acid level
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Larry is taking allopurinol to prevent gout. Monitoring of apatient who is taking allopurinol includes:
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BUN, creatinine, and creatinine clearance
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What are the adverseeffects of corticosteroids if administered for 6months or more?
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immunosuppressionand can mask s/s of infection
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Jane has been taking 10 mg per day of prednisone for the past 6months. She should be assessed for:
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Osteoporosis
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Patients whose total dose of prednisone will exceed 1 gram willmost likely need a second prescription for:
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Omeprazole, a proton pump inhibitor to preventpeptic ulcer disease
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Daniel has been on 60 mg of prednisone for 10 days to treat asevere asthma exacerbation. It is time to discontinue the prednisone. How isprednisone discontinued?
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Develop a tapering schedule to slowly weanDaniel off the prednisone
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Patients with rheumatoid arthritis who are on chronic low-doseprednisone will need co-treatment with which medications to prevent furtheradverse effects?
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A bisphosphonate, Calcium supplementation and Vitamin D
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Why is it important totaper the corticosteroid?
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Adrenalinsufficiency may result when the drug is stopped immediately
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What are the blackbox warnings on NSAIDS?
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cardiovascular risk and GI bleeding risk
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What are the signs ofaspirin toxicity?
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Respiratory Alkalosis isseen initially; hypernea and tachypnea occurrs a result of increase CO2.
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The trial period to determine effective anti-inflammatory activitywhen starting a patient on aspirin for rheumatoid arthritis is:
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4 to 6 days
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Patients prescribed aspirin therapy require education regarding thesigns of aspirin toxicity. An early sign of aspirin toxicity is:
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Tinnitus
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Monitoring a patient on a high dose aspirin level includes:
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Salicylate level, CBC, and urine pH
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Patients who are on long-term aspirin therapy should have ____annually.
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CBC
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Henry is 82 years old and takes two aspirin every morning to treatthe arthritis pain in his back. He states the aspirin helps him to “get going”each day. Lately he has had some heartburn from the aspirin. After ruling outan acute GI bleed, what would be an appropriate course of treatment for Henry?
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Add an H2 blocker such as ranitidine to his therapy
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