Bundle
NR 566/ NR566 CLASS NOTES & EXAMS GUIDE > CHAMBERLAIN COLLEGE OF NURSING
7 Items
NR 566 Week 1 Study Guide
NR566 Week 1 Study Outline Chapter 21: Drugs Affecting the Endocrine System Bisphosphonates • Drugs: etidronate (Didronel), pamidronate (Aredia), ris... [Show More] edronate (Actonel) alendronate (Fosamax), tiludronate (Skelid), zoledronic acid (Zometa), ibandronate (Boniva) • Used for bone support, most commonly used • Pharmacodynamics Adhere to bone, inhibit osteoclastic activity, potent inhibitors of both normal and abnormal bone resorption o Etidronate (Didronel): reduces both bone resorption and bone formation because formation is coupled with resorption o Pamidronate (Aredia) (available as IV only) o and risedronate (Actonel): inhibit bone resorption with out inhibiting bone formation and mineralization o Alendronate (Fosamax): highly selective inhibitor of bone resorption 1 100 to 500 time more potent than the other drugs Does not interfere with osteoclastic recruitment or attachment but does inhibit osteoclastic activity o Tiludronate (Skelid): inhibits protein-tyrosine-phosphatease, results in detachment of osteoclasts from the bone surface Inhibits the osteoclastic proton pump o Zoledronic acid (Zometa): inhibits osteoclastic activity and induces osteoclast apoptosis Also inhibits the increased osteoclastic activity and skeletal calcium release induced by various stimulatory factors release by tumors Only available as IV formulation o Ibandronate (Boniva): inhibits osteoclast activity and reduces bone resorption and turnover based on its affinity for hydroxyapatite (part of the bone matrix) • All drugs in this class reduce vertebral fracture however, o Only alendronate, risedronate, and zoledronic acid have demonstrated nonvertebral fracture reduction o Pamidronate and zoledronic acid: only for parenteral use • Pharmacotherapeutics o Contraindication: uncorrected hypocalcemia, documented Barrett’s esophagus, and renal insufficiency o Caution: patient with GI disorders o R/F severe esophageal adverse reactions is greater in patients who lie down after taking these drugs or fail to take with a full glass of water o Etidronate has been withheld from patients with enterocolitis r/t diarrhea particularly at high doses Associated with fracture in patients with Paget’s disease when given high doses or when therapy lasted longer than 6 months • Monitor with x-rays and lab work to assess for lesions • Rare femur fracture in non-Paget’s patients using bisphosphonates o IV formulations associated with higher renal toxicity risk especially with rapid infusion Check crt prior to every dose is required, force fluids before and after infusion • Clinical Use (Page 546 Dosing Chart) o Osteoporosis Prevention and treatment of osteoporosis and its risk for fracture in men and postmenopausal women (especially vertebral fractures) First line drugs: Alendronate, risedronate, and zolendronic acid with hip fracture reductions, FDA approved for this indication Second-line drug: Ibandronate Ibandronate and zoledronic acid come in IV form Alendronate PO solution (Binosto) and PO tablets Zoledronic acid: only alternative form that shows evidence of hip fracture reduction Prophylactic use in patients with early osteopenia r/t long term use of medications that contribute to bone loss • Includes (thyroid hormone, aromatase inhibitors, and glucocorticoids, PPIs, SSRIs) It is recommended that all adults taking more than 7.5 mg of prednisone or its equivalent for more than 3 weeks be given alendronate or risedrone In very high risk patients, maximum 2-year use of teriparatide (Forteo) (bone mass benefit disappears after d/c) a parathyroid hormone, may be more efficacious • Bisphosphonates: bone mass benefit does not decline for 5 years Alendronate and risedronate initial doses for prevention of bone loss: 5mg/day or 35mg/week For existing osteoporosis: alendronate 10mg/day or 70mg/week Risedronate: 75mg for 2 days or 150mg once a month o Paget’s Disease (Osteitis Deformans) All bisphosphonates are used to treat Paget’s disease when the alkaline phosphatase is at least twice the upper limit of normal Asymptomatic or at risk for future complications from their disease Symptomatic Paget’s best treated with etidronate Etidronate slows accelerated bone turnover in pagetic lesions and to a lesser extend in normal bone Reduced turnover causes symptomatic improvement: less bone pain and decreased fractures 5-10 mg/kg daily for up to 6 months or 11 to 20 mg/kg daily for 3 months For all drugs indications for retreatment are evidence of active disease or failure to normalize alkaline phosphatase levels Supplemental calcium and vitamin D if dietary intake is not adequate Space calcium supplements and bisphosphonates to prevent reduced bioavailability o Heterotopic Ossification Complications of THR Etidronate: first line Heterotopic ossification r/t spinal cord injury Use as soon as possible after injury • Drug Interactions o Adverse GI reactions, interact with drugs that affect the GI tract Histamine 2 blocking agents double alendronate bioavailability but the impact with unknow o Calcium supplements and antacids interfere with bisphosphonate absorption when taken within 1 hr o R/F GI bleeding is increased when ASA and NSAIDs are concomitantly taken o ASA may decrease the bioavailability of tiludronate by up to 50% when taken 2 hrs after the tiludronate o Indomethacin increases the bioavailability of tiludronate by 2- to 4- fold Diclofenac does not significantly alter bioavailability therefore each NSAID must be evaluated individually o Concurrent use of bisphosphonates and other drugs known to build bone density (estrogens and SERMs) have additive bone density however fracture reduction potential is unknown ... [Show Less]
- Class Notes
- $10.45
- 0
- 150
NR 566 Week 2 Study Guide
Drugs Affecting the Respiratory System Bronchodilators: Beta 2 Receptor Agonists (B2RA): Short and long acting beta agonists • B2RA widely used in... [Show More] all ages to treat reversible bronchoconstriction caused by reactive airway disease (RAD) or COPD • Bronchodilators • Short-acting beta agonists: Albuterol (ProAir, Ventolin, Proventil) , metaproterenol (Alupent), terbutaline (Brethine, Brethaire), bitolterol (Tornalate), pirbuterol (Maxair), and levalbuterol (Xopenex) • Long-acting beta agonists: arformoterol (Brovana), salmeterol (Serevent), formoterol (Foradil), and indacaterol (Arcapta Neohaler) • Drug of choice during pregnancy for asthma Pharmacodynamics • Act on smooth muscle to reverse bronchospasm, decreases airway resistance and residual volume and increasing VC and airflow • Stimulate beta 2 adrenergic receptors in the lungs to increase cAMP production which relaxes bronchial smooth muscle and inhibits mediators from hypersensitivity cells (mast cells) • All beta agonists stimulate beta 1 activity (increased HR, tremor)f Short Acting Beta Agonists • Albuterol o Selective beta2 agonist with minor beta1 activity o Often first-line drug r/t less ADRs than the other drugs in this class o Increases HR by stimulating beta 2 receptors in the heart and vascular smooth muscle • Levalbuterol: (similar to albuterol), where the (S)-isomer from racemic albuterol is removed • Pirbuterol: selective beta 2 agonist, similar to albuterol • Terbutaline: similar to albuterol, selective beta 2 with minor beta 1 activity o Known to inhibit uterine contractions • Metaproterenol: beta 2 selective with some beta 1 activity, less selective than albuterol or terbutaline • Bitolterol: hydrolyzed by esterase in the lung to colterol, or terbutylnorepinephrine, selective beta 2 Long Acting Beta Agonists (Salmeterol, formoterol, indacaterol, and aformoterol) • Salmeterol is more selective for beta2 receptors than albuterol and has minor beta1 activity. o 12 hour half-life o Formoterol: 200-fold greater agonist activity at B2 than albuterol and has minor B1 activity o Aformoterol (R,R)-enantiomer of formoterol, twice as potent as formoterol o Indacaterol: 24 fold greater B2 activity than B1 o Salmeterol and formoterol exert long-lasting broncho protection against allergen, exercise, histamine, and methacholine caused bronchospasm Pharmacokinetics • Contraindications: Cardiac arrhythmias (tachycardia or heart block caused by digitalis intoxication, angina, narrow-angle glaucoma, organic brain damage (epi only), and shock during general anesthesia with halogenated agents • Monitor closely: HTN, ischemic heart disease, coronary insufficiency, CGH, and Hx of stroke and/or cardiac arrhythmias • Diabetics: potential drug-induced hyperglycemia, insulin dose may need increased • Hyperthyroidism: ADRs are more likely to occur with use of bronchodilators • Digoxin: require close monitoring, albuterol increases the volume of distribution of dig and can cause decreased dig blood levels • Pheochromocytoma: avoid, severe HTN may occur • Older adults: Lower doses r/t increased sympathomimetic sensitivity • Black Box warning for LABAs: The risks of salmeterol (Serevent) and formoterol (Foradil) outweighed the benefits and should not be used singly in asthma for all ages o Two-fold increase in catastrophic events (asthma-related intubations and death) o The use of LABAs is contraindicated without the use of an asthma controller medication such as an inhaled corticosteroid o Only use long-term in patients who asthma cannot be adequately controlled on asthma controller medications o Use for the shortest duration of time required to achieve control, then maintain on an asthma controller medication o Pediatric and adolescent patient who require addition of a LABA to an inhaled corticosteroid should be a combination product containing both an inhaled ICS and a LABA, to ensure compliance with both medications • Terbutaline pregnancy category B (prevent contractions) (others category C) • Albuterol safe for all age children • Metaproterenol can be used in young children • Levalbuterol, as young as 2 (drug insert says 6) • Salmeterol should not be used in children less than age 4 years and never singly. • Formoterol age 5 and older • Indacaterol and aformoterol are used for COPD, not for use in children or adolescents Drug and Food Interactions o Many drug interactions o Digitalis glycosides: increased risk of dysrhythmia o Beta adrenergic blocking agents (Beta Blockers): direct competition for beta sites resulting in mutual inhibition of therapeutic effects o Including beta blocker eye drops o Tricyclic antidepressants and MAOIs potentiate effects of beta agonist on vascular system ADRs o Usually transient o Stopping the med is not usually needed, reduce dose then slowly increase o Supraventricular and ventricular ectopic beats have occurred o Tachycardia and palpitations o Some central nervous system (CNS) excitation effects o Tremors, dizziness, shakiness, nervousness, and restlessness o Headaches, rarely insomnia, post inhalation cough o Salmeterol has an increased risk of exacerbation of severe asthma symptoms if the patient is deteriorating o Overuse can lead to seizures, hypokalemia, anginal pain and HTN o Stimulant like effects o GI upset, take po meds with food Clinical Use and Dosing Bronchospasm • Bronchodilators are used primarily in the treatment of bronchospasm associated with asthma, bronchitis (acute or chronic), and chronic obstructive pulmonary disease (COPD) o Albuterol MDI dose children over 4 and adults is 2 puffs every 4 to 6 hours o Nebulizer dose children over age 12 and adults is 2.5 mg/dose For younger children over 15 kg, dose is 0.1 to 0.15 mg/kg/dose o Dose may be repeated once after 5 to 10 minutes, up to 2 times, three doses total during exacerbations o Oral dose in adults is 2 to 4 mg 3 or 4 times a day For children 6 to 12, 2 mg albuterol 3 to 4 times a day (PO form rarely used in children) Oral syrup: children under age 6, 0.1 mg/kg 3 times a day (rarely used) o May combine with ipratropium o Aformoterol (Brovana): nebulizer 15 mcg/ by inhalation BID (not approved for use in children) o Indacaterol (Arcapta Neohaler): powder via a Neohaler device adults with COPD, one capsule one daily with a Neohaler device o Levalbuterol (Xopenex): inhalation solution (nebulizer) in adolescents over age 12 and adults is 0.63 mg TID (every 6 to 8 hours) [Show Less]
- Study guide
- $8.80
- 0
- 141
NR566 Week 1,2 and 3 complete Study Outline Combined chapters > Chamberlain College Of Nursing
Chapter 21: Drugs Affecting the Endocrine System Bisphosphonates • Drugs: etidronate (Didronel), pamidronate (Aredia), risedronate (Actonel) alendrona... [Show More] te (Fosamax), tiludronate (Skelid), zoledronic acid (Zometa), ibandronate (Boniva) • Used for bone support, most commonly used • Pharmacodynamics Adhere to bone, inhibit osteoclastic activity, potent inhibitors of both normal and abnormal bone resorption o Etidronate (Didronel): reduces both bone resorption and bone formation because formation is coupled with resorption o Pamidronate (Aredia) (available as IV only) o and risedronate (Actonel): inhibit bone resorption with out inhibiting bone formation and mineralization o Alendronate (Fosamax): highly selective inhibitor of bone resorption 1 100 to 500 time more potent than the other drugs Does not interfere with osteoclastic recruitment or attachment but does inhibit osteoclastic activity o Tiludronate (Skelid): inhibits protein-tyrosine-phosphatease, results in detachment of osteoclasts from the bone surface Inhibits the osteoclastic proton pump o Zoledronic acid (Zometa): inhibits osteoclastic activity and induces osteoclast apoptosis Also inhibits the increased osteoclastic activity and skeletal calcium release induced by various stimulatory factors release by tumors Only available as IV formulation o Ibandronate (Boniva): inhibits osteoclast activity and reduces bone resorption and turnover based on its affinity for hydroxyapatite (part of the bone matrix) • All drugs in this class reduce vertebral fracture however, o Only alendronate, risedronate, and zoledronic acid have demonstrated nonvertebral fracture reduction o Pamidronate and zoledronic acid: only for parenteral use • Pharmacotherapeutics o Contraindication: uncorrected hypocalcemia, documented Barrett’s esophagus, and renal insufficiency o Caution: patient with GI disorders o R/F severe esophageal adverse reactions is greater in patients who lie down after taking these drugs or fail to take with a full glass of water o Etidronate has been withheld from patients with enterocolitis r/t diarrhea particularly at high doses Associated with fracture in patients with Paget’s disease when given high doses or when therapy lasted longer than 6 months • Monitor with x-rays and lab work to assess for lesions • Rare femur fracture in non-Paget’s patients using bisphosphonates o IV formulations associated with higher renal toxicity risk especially with rapid infusion Check crt prior to every dose is required, force fluids before and after infusion • Clinical Use (Page 546 Dosing Chart) o Osteoporosis Prevention and treatment of osteoporosis and its risk for fracture in men and postmenopausal women (especially vertebral fractures) First line drugs: Alendronate, risedronate, and zolendronic acid with hip fracture reductions, FDA approved for this indication Second-line drug: Ibandronate Ibandronate and zoledronic acid come in IV form Alendronate PO solution (Binosto) and PO tablets Zoledronic acid: only alternative form that shows evidence of hip fracture reduction Prophylactic use in patients with early osteopenia r/t long term use of medications that contribute to bone loss • Includes (thyroid hormone, aromatase inhibitors, and glucocorticoids, PPIs, SSRIs) It is recommended that all adults taking more than 7.5 mg of prednisone or its equivalent for more than 3 weeks be given alendronate or risedrone In very high risk patients, maximum 2-year use of teriparatide (Forteo) (bone mass benefit disappears after d/c) a parathyroid hormone, may be more efficacious • Bisphosphonates: bone mass benefit does not decline for 5 years Alendronate and risedronate initial doses for prevention of bone loss: 5mg/day or 35mg/week For existing osteoporosis: alendronate 10mg/day or 70mg/week Risedronate: 75mg for 2 days or 150mg once a month o Paget’s Disease (Osteitis Deformans) All bisphosphonates are used to treat Paget’s disease when the alkaline phosphatase is at least twice the upper limit of normal Asymptomatic or at risk for future complications from their disease Symptomatic Paget’s best treated with etidronate Etidronate slows accelerated bone turnover in pagetic lesions and to a lesser extend in normal bone Reduced turnover causes symptomatic improvement: less bone pain and decreased fractures 5-10 mg/kg daily for up to 6 months or 11 to 20 mg/kg daily for 3 months For all drugs indications for retreatment are evidence of active disease or failure to normalize alkaline phosphatase levels Supplemental calcium and vitamin D if dietary intake is not adequate Space calcium supplements and bisphosphonates to prevent reduced bioavailability o Heterotopic Ossification Complications of THR Etidronate: first line Heterotopic ossification r/t spinal cord injury Use as soon as possible after injury • Drug Interactions o Adverse GI reactions, interact with drugs that affect the GI tract Histamine 2 blocking agents double alendronate bioavailability but the impact with unknow o Calcium supplements and antacids interfere with bisphosphonate absorption when taken within 1 hr o R/F GI bleeding is increased when ASA and NSAIDs are concomitantly taken o ASA may decrease the bioavailability of tiludronate by up to 50% when taken 2 hrs after the tiludronate o Indomethacin increases the bioavailability of tiludronate by 2- to 4- fold Diclofenac does not significantly alter bioavailability therefore each NSAID must be evaluated individually o Concurrent use of bisphosphonates and other drugs known to build bone density (estrogens and SERMs) have additive bone density however fracture reduction potential is unknown • ADRs o All bisphosphonates: musculoskeletal pain More common in Paget’s disease More common in those taking risedronate High doses of etidronate Rare reports of osteonecrosis of the jaw in active dental disease, invasive procedure, especially in CA patients • Can occur without dental issues in those receiving frequent high IV doses R/F A-fib • Bioavailability of bisphosphonate drugs and appropriate patient education o Absorption and bioavailability of oral doses are significantly reduced by the presence of food in the gut or other preparations containing divalent cations o To enhance absorption take with 8 oz of water, no other food or drink and remain upright for at least half an hr (1 hour with ibandronate) o Histamine 2 blocking agents double alendronate bioavailability but the impact with unknow o ASA may decrease the bioavailability of tiludronate by up to 50% when taken 2 hrs after the tiludronate o Indomethacin increases the bioavailability of tiludronate by 2- to 4- fold Diclofenac does not significantly alter bioavailability therefore each NSAID must be evaluated individually o Patient education: Take oral drugs first thing in the morning at least 30 minutes prior to other medications, beverages, or food (60 minutes for ibandronate) o Etidronate and tiludronate take 2 hours before food o Alendronate, ibandronate, risedronate, and tiludronate should be taken with 8 oz of plain water o Mineral water, coffee, OJ, and other drinks greatly reduce absorption o Supplemental calcium or antacids take the bisphosphonate at least 1 hr before these drugs o Skip missed daily doses and resume the next morning o Sit up for at least 30 mins after taking to decrease risk of esophageal irritation (1hr for ibandronate) • Adverse effects associated with long-term use o Etidronate: Fractures in patients with Paget’s disease when given high doses or when therapy lasted longer than 6 months o Oral drugs in this class: rare osteonecrosis of the jaw after 3 years of use (higher risk in IV drugs) Growth hormones • Drugs: somatropin (Nutropin and Nutropin AQ, Gentropin, Humatrope, Norditropin, Nutropin, Accretropi9n, Saizen, Serostim) and somatrem (Protropin) • Dosage of the various forms of somatropin varies by manufacturer • Pharmacodynamics o GHRH secreted by hypothalamus in response to decreased serum glucose o GHRH then binds to receptors in the anterior pituitary, secrets GH (somatotropin) o Passes through cell membrane, fosters proteins synthesis, fat breakdown, and tissue growth o Causes hyperglycemia by decreasing glucose utilization by cells and increases rate by which glycogen is broken down into glucose o Both GHRH and GH have been synthesized by recombinant DNA technology Synthetic hormones o Administration results in an insulin like effect o Increased growth of organs and skeletal, increased cellular protein synthesis o Children with GH deficiency sometimes experience hypoglycemia and it is improved by admin of these drugs o Reduction in fat store, increased lean muscle mass, and decreased mean cholesterol o Treats lipodystrophy in HIV patients – helps to reduce wasting and cachexia o In over abundance of GH, surgical intervention is primary intervention however recurrence may require use of somatostatin analogues such as octreotide or lancreotide GH suppressive agents • Pharmacotherapeutics o Contraindication: patients with closed epiphyses and those with evidence of active tumore growth o Caution: o intracranial tumors increased r/f tumor growth o Patients with coexisting adrenocorticotropic hormone deficiency may experience increased symptoms o Increased serum levels of inorganic phosphorus, alkaline phosphatase, and parathyroid hormone o TH level changes have occurred Makes managing thyroid disorders more difficult Untreated hypothyroidism prevents optimal response to GH therapy o May induce insulin resistance o Use cautiously with diabetic patients, those with glucose intolerance, or risk for metabolic syndrome Lipid benefits may negate this risk o Safety and efficacy of synthetic GH not established in pregnancy or lactation, Category C, only if clearly needed • Clinical Use (Dosing Schedule: Pg 551) o Growth Failure Associated with Chronic Renal Insufficiency GH is used to treat children with growth failure up to the time of renal transplantation • Dosages are higher than normal r/t hormone resistance After transplantation use is restricted to children 2 standard deviations below the mean for their gender without epiphyseal closure GH increased the side effects of cyclosporine, so typically evaluated 1 year after transplant for continued use To optimize therapy for those receiving hemodialysis, injections are given at night prior to going to sleep or at least 3 to 4 hrs after dialysis to prevent hematoma formation caused by the heparin For those with peritoneal dialysis: take injection in the morning after dialysis is completed Ambulatory peritoneal dialysis: injection in the evening at the time of the overnight exchange o Long-term Treatment of Growth Failure in Children who lack adequate Endogenous GH Somatrem and all forms of somatropin (except Serostim) used for this indication Titrated to individual patient response Younger children respond better than prepubertal adolescents High doses increase risk for excess human GH o Turner’s Syndrome Somatropin is approved for long-term treatment of short stature associated with TS Specific dosing schedule is individualized Relative hormone resistance is common (higher doses to obtain growth) o Somatropin Deficiency Patients must meet strict criteria to receive GH, prescribed by endocrinology team • Drug Interactions o Glucocorticoid therapy and estrogens may inhibit the growth-promoting effect of GH o Anticonvulsants may have more severe side effects o Insulin may lose its effectiveness [Show Less]
- Summary
- $13.80
- 0
- 171
NR 566 Week 7 Study Guide
NR 566 Week 7 Study Guide Chapter 48: Women as Patients Pharmacokinetic gender differences between men and women These three medications have shown ... [Show More] differences that are clearly significant between men and women Propranolol (Inderal): early drug that showed a clear gender difference in metabolism (clearance) o PO doses: significantly higher (63%) rate of clearance in men than women o IV doses do not do this: indicates hepatic first pass metabolism o Women: show a significantly greater clinical response to PO doses Verapamil (Isoptin, Calan): PO clears more quickly in men than women based on CYP3A4 o Higher absolute bioavailability in women causes greater pharmacodynamic effects on BP and HR in women Erythromycin: more effective in women o More rapidly cleared in women than men r/t CYP 3A4 Pharmacokinetic Parameter Sex-Based Difference Absorption and bioavailability • Gastric emptying time is slower in females, mainly related to the effects of estrogen. Drugs absorbed in the stomach will have longer exposure to absorption sites. • Gastric levels of alcohol dehydrogenase are lower in females. Plasma concentrations are greater in females than males after ingestion of similar amounts of alcohol. • Gastric acid secretion, pH, osmolality, electrolyte concentrations, and levels of bile acids and proteins do not vary significantly between sexes. Distribution • Females have lower body weights and BMI than males. • Females have a higher proportion of body fat. Lipophilic drugs are more readily absorbed and have relatively greater volumes of distribution than hydrophilic drugs. • Plasma volume is lower in females. Drugs with high volumes of distribution will be more concentrated in the plasma of females. • Organ blood flow is lower in females. • Estrogen is distributed attached to a serum-binding globulin. Exogenous estrogens increase levels of many serum-binding globulins such as corticosteroid-binding globulin and thyroxine-binding globulin resulting in less free drug. [Show Less]
- Summary
- $9.00
- 0
- 188
NR 566 Week 1 Notes
Drugs Affecting the Endocrine System Bisphosphonates Pharmacokinetics Absorption and Distribution o All oral bisphosphonates potentially cause esop... [Show More] hagitis and gastric irritation o Absorption and bioavailability of oral doses are significantly reduced by the presence of food in the gut or other preparations containing divalent cations. o To enhance absorption, the patient takes the drug with 8 oz of water, No other food or drink should be ingested, and the patient must remain upright for at least half an hour (1 hour with ibandronate). o all mainly distributed to bone. o Their terminal half-life in bone is exceedingly long, varying from more than 10 years for alendronate to more than 90 days for etidronate. o The half-life of risedronate is much shorter, at 480 hours; ibandronate is 220 hours; zoledronic acid is 167 hours; and tiludronate is 150 hours these times are thought to represent the dissociation of the drug from the bone surface, rather than its time within the bone. o Most bisphosphonates are Pregnancy Category C. Pamidronate and zoledronic acid are Category D o All bisphosphonates are used with extreme caution during breastfeeding; zoledronic acid binds to bone for long periods so is never used in lactating mothers. o Safety and efficacy in children have not been fully established, but children have been treated with etidronate (Pregnancy Category B) at doses recommended for adults to prevent heterotopic ossifications or soft tissue calcifications Metabolism and Excretion o no evidence that any are systemically metabolized. o Drug that is not distributed to bone is largely excreted in the urine. o these drugs are not recommended for patients with moderate to severe renal impairment (serum creatinine greater than 4.9; creatinine clearance (CCr) less than 30 to 35 mL/min). Dosage adjustments may be necessary if the drug must be given Pharmacodynamics (MOA) adhere tightly to bone and, by inhibiting osteoclastic activity, are potent inhibitors of both normal and abnormal bone resorption. Etidronate (Didronel) reduces both bone resorption and bone formation because formation is coupled with resorption. Pamidronate (Aredia) and risedronate (Actonel) inhibit bone resorption without inhibiting bone formation and mineralization Alendronate (Fosamax) is a highly selective inhibitor of bone resorption and is 100 to 500 times more potent than the other drugs. o does not interfere with osteoclast recruitment or attachment, o does inhibit osteoclastic activity Tiludronate (Skelid) inhibits osteoclastic activity through two different mechanisms. o It inhibits protein-tyrosine-phosphatase, resulting in detachment of osteoclasts from the bone surface, o It inhibits the osteoclastic proton pump. Zoledronic acid (Zometa) inhibits osteoclastic activity and induces osteoclast apoptosis. o also inhibits the increased osteoclastic activity and skeletal calcium release induced by various stimulatory factors released by tumors. Ibandronate (Boniva) inhibits osteoclast activity and reduces bone resorption and turnover based on its affinity for hydroxyapatite, which is part of the mineral matrix of the bone All reduce vertebral fractures only aldendronate, risedronate, and zoledronic acid have demonstrated nonvertebral fracture reductions; it cannot be assumed the others can achieve the same endpoint o these three have been have been studied in men, but transferability of results with other medications is considered a safe assumption. pamidronate and zoledronic acid are available only for parenteral use, they are (not discussed in detail except to alert the primary care provider about monitoring the drug and its place in the total treatment regimen of the patient.) Pharmacotherapeutics Precautions and Contraindications o no absolute contraindications except uncorrected hypocalcemia, documented Barrett's esophagus, and renal insufficiency o Cautious use is recommended for patients with gastrointestinal (GI) disorders. o The risk for severe esophageal adverse reactions is greater in patients who lie down after taking these drugs or who fail to swallow them with a full glass (8 oz) of water. o Etidronate has been withheld from patients with enterocolitis because diarrhea has occurred in some patients, particularly at high doses. o Etidronate has also been associated with fractures in patients with Paget's disease when they are given high doses or when therapy lasted longer than 6 months. These patients must be carefully monitored with x-rays and laboratory work to assess for these lesions. o IV formulations associated with higher renal toxicity risk, especially with rapid infusion. o Checking serum creatinine prior to every dose is required. o Forcing fluids before and after infusion is also recommended Adverse Drug Reactions musculoskeletal pain. more common for patients with Paget's disease and in those taking risedronate and higher doses of etidronate. Rare osteonecrosis of the jaw If elective dental procedures are planned, drug cessation for 3 months pre- and post-procedure may decrease the risk, no evidence to support this plan Some concerns have arisen about increased risk of atrial fibrillation. Drug Interactions Because of these drugs' adverse reactions on the GI tract, drug interactions are most common with other drugs that also affect the GI tract. Histamine2 blocking agents double alendronate bioavailabilityimpact is unknown Calcium supplements and antacids interfere with bisphosphonate absorption when taken within 1 hour of each other. The risk of GI bleeding is increased when aspirin and NSAIDs are concomitantly taken Aspirin may decrease the bioavailability of tiludronate by up to 50% when taken 2 hours after the tiludronate. each NSAID must be considered individually o indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly altered by diclofenac Concurrent use of bisphosphonates and other drugs known to build bone density, such as estrogens and SERMs, prove to have additive bone density, but fracture reduction potential is unknown. The safety of combination therapy appears to be the same as the use of each drug separately o reserved for extreme cases where one drug is inadequate. Clinical Use – Osteoporosis prevention and treatment of osteoporosis and its risk for fractures in men and postmenopausal women, especially vertebral fractures. The best trials have been done with alendronate, risedronate, and zoledronic acid with hip fracture reductions have received FDA approval for this indication. Ibandronate is considered a second-line drug o Ibandronate and zoledronic acid come in an IV form and alendronate has an oral solution (Binosto) for those patients unable to take tablets. o Among these alternative forms, only the zoledronic acid shows evidence of hip fracture reduction. Initial doses for prevention of bone loss for alendronate and risedronate are 5 mg/day or 35 mg/week. For treatment of existing osteoporosis, the dose of alendronate doubles to 10 mg/day or 70 mg/week, and the dose of risedronate increases to 75 mg for 2 consecutive days or 150 mg once a month Therapy with 10 mg daily can increase bone density by up to 10% after 3 years and can decrease vertebral and hip fractures by 50% Use for more than 4 years is currently under review concerning its efficacy or safety. A “drug holiday” for up to 3 years may be considered for lower-risk patients; higher-risk patients are encouraged to remain on therapy due to a better risk versus harm profile The initial and maintenance dosage of ibandronate for both prevention and treatment is one 2.5 mg tablet taken daily or one 150 mg tablet taken once monthly on the same date of each month. o The IV dose is 3 mg given over 30 seconds and repeated every 3 months, a schedule that must be closely maintained for best results. Another IV osteoporosis treatment and fracture prevention medication is zoledronic acid (5 mg), which is taken only yearly. The 4 mg dosing is typically reserved for monthly cancer metastasis prevention and treatment. All bisphosphonates are used to treat Paget's disease when the alkaline phosphatase is at least twice the upper limit of normal. They may also be used for those who are asymptomatic or at risk for future complications from their disease When heterotopic ossification is a complication of total hip replacement, etidronate may be used at 20 mg/kg daily for 1 month pre-operatively and 20 mg/kg daily for 3 months post-operatively. o Etidronate is also used when heterotopic ossification occurs secondary to spinal cord injury. The dosage then is 20 mg/kg daily for 2 weeks, followed by 10 mg/kg daily for 10 weeks, begun as soon as possible after the injury and prior to evidence of heterotopic ossification. Use for early osteopenia related to long-term use of medications that contribute to bone loss (what drugs increase the risk of osteopenia?) Practitioners should consider prophylactic use of bisphosphonates in patients with early osteopenia related to long-term use of medications that contribute to bone loss o Such asthyroid hormone, aromatase inhibitors, and glucocorticoids o The use of PPIs and SSRIs are newly linked with significant bone loss at a level equal to that of glucocorticoids It is recommended that all adults taking more than 7.5 mg of prednisone or its equivalent for more than 3 weeks be given alendronate or risedronate In very high-risk patients, a maximum 2-year use of teriparatide (Forteo), a parathyroid hormone, may be more efficacious The bone mass benefit disappears after teriparatide discontinuance, a decline not seen with the bisphosphonates for 5 years. Concerns about a cancer link (osteosarcoma) need to be considered with the use of teriparatide. Monitoring Before beginning treatment, rule out common treatable disorders that can also cause low bone density. ( hyperparathyroidism, vitamin D deficiency, hyperthyroidism, and renal disease) o Tests for these disorders are serum calcium and albumin, 25-hydroxy vitamin D, thyroidstimulating hormone (TSH), and serum creatinine levels Serum creatinine levels are drawn prior to initiating therapy. [Show Less]
- Class Notes
- $8.00
- 0
- 207
NR 566 Week 6 Study Guide
Androgen drugs o Testosterone is the primary male androgen o Responsible for: Growth, maturation, and maintenance of male sex organs and seconda... [Show More] ry sexual characteristics Skeletal growth spurt in adolescence and termination of linear growth by fusion of the epiphyseal growth plate Activation of sebaceous glands (acne during puberty) Enhances production of erythropoietic stimulating factor, increased RBCs production Libido o Androgen Drugs: testosterone propionate (in oil, DepoTesterone), testosterone enanthate (in oil, Delatestryl), testosterone cypionate (in oil, Depo-Testosterone), methyltestosterone (Android, Methitest, Testred, Virilon), testosterone gel (AndroGel 1%, AndroGel 1.62%, Axiron, Testium), fluoxymesterone, TD testosterone (Testoderm, Androderm), and buccal testosterone (Striant) Used to treat Indicated for the symptomatic Tx of 1) deficiency states in males associated with hypogonadism and 2) in both sexes for d/os such as CA and HIB, Tx libido, endometriosis, and postmenopausal symptoms in women, have been used illicitly to enhance athletic performance and increase muscle mass o Contraindicated: male breast CA, prostate CA, and Pregnancy (Category X), and lactation Antiandrogens: several different categories o Androgen hormone inhibitors (5-alpha-reductase inhibitors) Drugs: Finasteride (Propecia, Proscar) and dutasteride (Avodart) MOA: Block conversation of testosterone to dihydrotesterone Used to Tx BPH PSA levels and digital prostate examination are required monitoring for men on these agents Finasteride (Propecia, Proscar): Extensive hepatic metabolism BPH: 5mg/day, 6 to 12 months of therapy until therapeutic response o Regression of prostate size increased urinary flow, and improve BPH symptoms Approved for Male pattern baldness: 1 mg/day, three months until results Stopping the drugs reverses the effect within 12 months ADRs: decreased libido, impotence (can occur at both doses) Dutasteride (Avodart) Inhibits both type 1 and 2 (5-alpha-reductase) Peak clinical effect 6 to 12 months of therapy Extensively metabolized in the liver (CYP3A4 and CYP3A5) Used to Tx BPH Absorbed through the skin, women who are pregnant or may become pregnant should not handle dutasteride capsules r/t risk of fetal anomaly to a male fetus ADR: decreased libido and impotence o Gonadotropin-releasing hormone analogue: luteinizing hormone-releasing hormone antagonist Leuprolide acetate (Lupron) Create a reversible chemical orchiectomy state in males and an oophorectomy state in females Used to Tx: advanced prostatic CA and for management of endometriosis and uterine leiomyomata (fibroids) 1 mg SC daily or IM every 3 months (depot formulation) Increased suppression when used with flutamide (direct antiandrogen) Peds: Tx central precocious puberty Women: reducing uterine fibroids, endometriosis, and PCOS (pain relief, regain fertility) o Direct antiandrogens Flutamide (Eulexin), bicalutamide (Casodex), and nilutamide (Nilandron) Inhibit androgen uptake or nuclear binding of androgen at target tissues Uses as part of combo therapy Tx of prostatic carcinoma Flutamide: competitive antagonist at the androgen receptor site Truly a nonsteroidal agent ADRs: gynecomastia and reversible liver toxicity Renal doses: less than 29 mL/min BLACK BOX WARNING: hepatic failure, hepatic encephalopathy, and death o Usually within the first 3 months of therapy o Baseline and monthly LFTs for the first 4 months of therapy and periodically o D/c if any symptoms of hepatic injury or jaundice develop [Show Less]
- Summary
- $8.45
- 0
- 151
NR 566 WEEK 5. 6, 7 - QUESTIONS AND ANSWERS
Week 5 Ch. 18 Drugs Affecting the Hematopoietic System 1. Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The ... [Show More] best recommendation is: A. Ibuprofen 400 mg three times a day B. Acetaminophen, not to exceed 4 grams per day C. Prescribe acetaminophen with codeine D. Aspirin 640 mg three times a day 2. Juanita had a DVT and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to: A. Contact the hospitalist as this is not the normal guideline for proscribing these two medications and she may have had a more complicated case B. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness C. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission D. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times 3. The safest drug to use to treat pregnant women who require anticoagulant therapy is: A. Low molecular weight heparin B. Warfarin C. Aspirin D. Heparin 4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? A. Pregnant women B. Elderly men C. Overweight or obese patients D. Patients with multiple comorbidities 5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be: A. Administer one dose of low-molecular weight heparin 24 hours before travel B. Prescribe one dose of warfarin to be taken the day of travel C. Consult with a hematologist regarding a treatment plan for Cecil D. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling 6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? A. He has arthritis and this will help with the inflammation and pain. B. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. C. Aspirin acidifies the urine and he needs this for prostrate health. D. He has a history of GI bleed, and one aspirin a day is a safe dose. 7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity she would need to be evaluated for: A. Tinnitus B. Diarrhea C. Hearing loss D. Photosensitivity 8. Patient education when prescribing clopidogrel includes: A. Do not take any herbal products without discussing with the provider B. Monitor urine output closely and contact the provider if it decreases C. Clopidogrel can be constipating, use a stool softener if needed D. The patient will need regular anticoagulant studies while on clopidogrel 9. For patients taking warfarin INRs are best drawn: A. Monthly throughout therapy B. Three times a week throughout therapy C. Two hours after the last dose of warfarin to get an accurate peak level D. In the morning if the patient takes their warfarin at night 10. Patients receiving heparin therapy require monitoring of: A. Platelets every 2 to 3 days for thrombocytopenia that may occur on Day 4 of therapy B. Electrolytes for elevated potassium levels in the first 24 hours of therapy C. INR throughout therapy to keep in the range around 2.0 D. Blood pressure for hypertension that may occur in the first 2 days of treatment 11. The routine monitoring recommended for low molecular weight heparin is: A. INR every 2 days until stable then weekly B. aPTT every week while on therapy C. Factor Xa levels if patient is pregnant D. White blood cell count every 2 weeks 12. When writing a prescription for warfarin it is common to write on the prescription. A. OK to substitute for generic B. The brand name of warfarin and Do Not Substitute C. PRN refills D. Refills for 1 year 13. Education of patients who are taking warfarin includes discussing their diet. Instructions include: A. Avoiding all vitamin K-containing foods B. Avoiding high vitamin K-containing foods C. Increasing intake of iron-containing foods D. Making sure they eat 35 grams of fiber daily 14. Patients who are being treated with epoetin alfa need to be monitored for the development of: A. Thrombocytopenia B. Neutropenia C. Hypertension D. Gout 15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that: A. ESAs no longer be prescribed to patients with chronic renal failure B. The risk of tumor development be explained to cancer patients on ESA therapy C. Patients should no longer receive ESA therapy to prepare for allogenic transfusions D. ESAs be prescribed only to patients younger than age 60 years 16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in: A. 6 weeks if they are a cancer patient B. 1 week if they have chronic renal failure C. 2 weeks if taking for allogenic transfusion D. Weekly throughout therapy 17. Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed: A. Folic acid to prevent megaloblastic anemia B. Iron, to start when the epogen starts C. An antihypertensive to counter the adverse effects of epogen D. Vitamin B12 to prevent pernicious anemia 18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes: A. Reticulocyte count 1 week after therapy is started B. Complete blood count every 2 weeks throughout therapy C. Hemoglobin level at 1 week of therapy D. INR weekly throughout therapy 19. Patient education regarding taking iron replacements includes: A. Doubling the dose if they miss a dose to maintain therapeutic levels B. Taking the iron with milk or crackers if it upsets their stomach C. Iron is best taken on an empty stomach with juice D. Antacids such as Tums may help the upset stomach caused by iron therapy 20. Patients with pernicious anemia require treatment with: A. Iron B. Folic acid C. Epogen alpha D. Vitamin B12 21. The first lab value indication that Vitamin B12 therapy is adequately treating pernicious anemia is: A. Hematocrit levels start to rise B. Hemoglobin levels return to normal C. Reticulocyte count begins to rise D. Vitamin B12 levels return to normal 22. Patients who are beginning therapy with Vitamin B12 need to be monitored for: A. Hypertensive crisis that may occur in the first 36 hours B. Hypokalemia that occurs in the first 48 hours C. Leukopenia that occurs at 1 to 3 weeks of therapy D. Thrombocytopenia that may occur at any time in therapy 1. Week 5 Chapter 19: Drugs Affecting the Immune System Attenuated vaccines are also known as: A. Killed vaccines B. Booster vaccines C. Inactivated vaccines D. Live vaccines 2. Live attenuated influenza vaccine (FluMist) may be administered to: A. All patients over 6 months of age B. Patients between age 2 years and 49 years with no risk factors C. Patients with a URI or asthma D. Pregnant women 3. The reason that two MMR vaccines at least a month apart are recommended is: A. The second dose of MMR “boosts” the immunity built from the first dose B. Two vaccines 1 month apart is the standard dosing for all live virus vaccines C. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine D. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR 4. MMR vaccine is not recommended for pregnant women because: A. Pregnant women do not build adequate immunity to the vaccine B. There is a risk of the pregnant women developing measles encephalopathy C. There is a risk of the fetus developing congenital rubella syndrome D. Pregnant women can receive the MMR vaccine 5. If the MMRV (measles, mumps, rubella, and varicella) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the CDC recommends: A. Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella 2 shot regimen B. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity C. Patients be premedicated with acetaminophen 15 minutes before the vaccine is given D. Patients should not be around pregnant women for the first 48 hours after the vaccine is given 6. The rotavirus vaccine (RotaTeq, Rotarix): A. Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus B. Should not be administered to infants who are or may be potentially immunocompromised C. Is not given to an infant who has a febrile illness (temperature greater than 100.5°F) D. All of the above 7. Varicella vaccine is recommended to be given to patients who are: A. HIV positive with a CD4+ T-lymphocyte percentage less than 15 percent B. Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day) C. Pregnant D. Immunocompromised 8. Zoster vaccine (Zostavax) is: A. A live varicella zoster vaccine from the same strain used to develop the varicella vaccine B. Effective in preventing varicella zoster in patients of all ages C. Recommended for patients age 40 to 80 who have had chickenpox D. Administered at the same time as other live vaccines, as long as they are given the same day 9. True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include: A. Fever up to 104°F (40.5°C) after previous DTaP vaccine B. Family history of seizures after DTaP vaccine C. Adolescent pregnancy D. Anaphylactic reaction with a previous dose 10. Hepatitis B vaccine (HBV) is contraindicated in patients who: A. Were born less than 32 weeks gestation (give first dose at age 6 months) B. Are pregnant C. Are on hemodialysis D. Are allergic to yeast 11. Human papillomavirus (HPV) vaccine (Gardasil, Cervarix): A. Is a live virus vaccine that provides immunity to six strains of HPV virus B. Has a common adverse effect of syncope within 15 minutes of giving the vaccine C. Should not be given to males younger than age 12 years D. May be given to pregnant women 12. Influenza vaccine may be administered annually to: A. Patients with egg allergy B. Pregnant patients C. Patients age 6 weeks or older D. Patients with acute febrile illness 13. Immune globulin serums (IGs): A. Provide active immunity against infectious diseases B. Are contraindicated during pregnancy C. Are heated to above body temperature to kill most hepatitis, HIV, and other viruses such as parvovirus D. Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population 14. Hepatitis B immune globulin (HBIG) is administered to provide passive immunity to: A. Infants born to HBsAg-positive mothers B. Household contacts of hepatitis-B virus infected people C. Persons exposed to blood containing hepatitis B virus D. All of the above 15. Rho(D) immune globulin (RhoGAM) is given to: A. Infants born to women who are Rh positive B. Sexual partners of Rh positive women C. Rh negative women after a birth, miscarriage, or abortion D. Rh negative women at 36 weeks gestation 16. Tuberculin purified protein derivative (PPD): A. Is administered to patients who are known tuberculin-positive reactors B. May be administered to patients who are on immunosuppressives C. May be administered 2 to 3 weeks after an MMR or varicella vaccine D. May be administered the same day as the MMR and/or varicella vaccine 17. Diane may benefit from cyclosporine (Sandimmune). Cyclosporin may be prescribed to: A. Treat rheumatoid arthritis B. Treat patients with corn allergy C. Pregnant patients D. Treat patients with liver dysfunction 18. Azathioprine has significant adverse drug effects, including: A. Hypertension B. Hirsutism C. Risk of cancer D. Gingival hyperplasia Week 5 Chapter 27 Anemia Pernicious anemia is treated with: A. Folic acid supplement B. Thiamine supplement C. Vitamin B12 D. Iron 2. Premature infants require iron supplementation with: A. 10 mg/day of iron B. 2 mg/kg per day until age 12 months C. 7 mg/day in diet D. 1 mg/kg per day until adequate intake of iron from foods 3. Breastfed infants should receive iron supplementation of: A. 3 mg/kg per day B. 6 mg/kg per day C. 1 mg/kg per day D. Breastfed babies do not need iron supplementation 4. Valerie presents to clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of iron supplementation C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID 5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of elemental iron C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID 6. Monitoring for a patient taking iron to treat iron deficiency anemia is: A. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started B. Complete blood count every 4 weeks throughout treatment C. Annual complete blood count D. Reticulocyte count in 4 weeks 7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: A. Take the iron with milk if it upsets her stomach B. Antacids may help with the nausea and GI upset caused by iron C. Increase fluids and fiber to treat constipation D. Iron is best tolerated if it is taken at the same time as her other medications 8. Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? A. 40 mcg/day B. 400 mcg/day C. 800 mcg/day D. 2 gm/day 9. Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: A. Oral folic acid 1 to 2 mg per day B. Oral folic acid 1 gram per day C. IM folate weekly for at least 6 months D. Oral folic acid 400 mcg daily 10. Patients who are being treated for folate deficiency require monitoring of: A. Complete blood count every 4 weeks B. Hematocrit and hemoglobin at 1 week and then at 8 weeks C. Reticulocyte count at 1 week D. Folate levels every 4 weeks until hemoglobin stabilizes 11. The treatment of vitamin B12 deficiency is: A. 1,000 mcg daily of oral cobalamin B. 2 gm per day of oral cobalamin C. 100 mcg/day Vitamin B12 IM D. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week 12. The dosage of Vitamin B12 to initially treat pernicious anemia is: A. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month B. Vitamin B12 IM monthly C. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg weekly for a month D. Oral cobalamin 1,000 mcg daily 13. Before beginning IM Vitamin B12 therapy, which laboratory values should be obtained? A. Reticulocyte count, hemoglobin, and hematocrit B. Iron C. Vitamin B12 D. All of the above 14. should be monitored when Vitamin B12 therapy is started. A. Serum calcium B. Serum potassium C. Ferritin D. C-reactive protein 15. Anemia due to chronic renal failure is treated with: A. Epoetin alfa (Epogen) B. Ferrous sulfate C. Vitamin B12 D. Hydroxyurea Week 5 Chapter 37: HIV The goals of treatment when prescribing antiretroviral medication to patients with HIV include: A. Prevent vertical HIV transmission B. Improve quality of life C. Prolong survival D. All of the above 2. A challenge faced with antiretroviral therapy (ART) is: A. Patients abusing ART B. Drug-resistant mutations of HIV [Show Less]
- Exam
- $14.45
- 0
- 186
Purchase the bundle to get the full access instantly
- 3 Million+ Study Documents
- 100% Money Back Guarantee
- Immediate Download Access
Add To Cart
Reviews 0
Bundle Details
$30.45
- Trusted by 800,000+ Students
- 24/7 Money Back Guarantee
- Download is directly available
179
0
Seller Details
