NR 566 / NR566 Advanced Pharmacology Care of the Family Midterm Review| LATEST 2021
/2022 | Chamberlain College
1. How to measure therapeutic effect
... [Show More] of HIV therapy
- RNA LEVELS
o baseline
o 2-4 weeks, no later than 8 weeks
o every 4-8 weeks until suppressed
o after suppressed every 3-4 months
- Long-term virologic suppression x2 years
o every 6 months
- any change in status = chemo/steroids
o every 3 months
2. Protease Inhibitor (PIs) Lopinavir - high risk patients
- ORAL solution: Contraindicated for full-term infants (until 14 days after birth) and premature (until 14 days after due date)
o cardiac disease
o Hx prolong QT
3. Protease Inhibitor (PIs) Lopinavir - Lifespan considerations
- Children: Safe after 14 days old
- Pregnancy: approved w/ higher risks
4. Protease Inhibitor (PIs) Lopinavir/ritonavir - adverse effects
- - QT prolongation
5. Protease Inhibitor (PIs) Saquinavir - Lifespan considerations
- Children
o Not identified as safe/efficient in children younger than 16
- Pregnancy
o Safest PI for pregnancy
- HIV treatment is recommended in pregnancy
6. Protease Inhibitor (PIs) Saquinavir - adverse reactions
- - QT prolongation
7. Nucleoside/nucleotide Reverse Transcriptase Inhibitor (NRTIs). Didanosine (ddI) - high risk patient
- Increase risk of pancreatitis with alcohol use, pancreatitis, and IV pentamide
8. Nucleoside/nucleotide Reverse Transcriptase Inhibitor (NRTIs). Didanosine (ddI) - Lifespan considerations
- Children
o approved in 6 years + weighing 20kg
- Pregnancy
o Less risk
9. Nucleoside/nucleotide Reverse Transcriptase Inhibitor (NRTIs). Zidovudine - Lifespan consideration
- Children
o neonates
- Pregnancy
o increased risk
10. Nucleoside/nucleotide Reverse Transcriptase Inhibitor (NRTIs): Zidovudine - high risk patients
- Hx of
o granulocytosis
o low H&H
o low vit B12
o low folic acid
o current use of meds that cause myelosuppe
11. How to measure therapeutic effect of HIV therapy
- CD4 counts
o w/ suppressed RNA levels = increase CD4 levels
- Check levels
o baseline
o at 3 month mark
o during 1st 2 years every 3-6 months during therapy
o long-term suppression
- CD4 <300 = every 3-6 months
- CD4 consistently b/w 300-500 = every 12 months
- CD4 >500 = optional
12. Suzanne is pregnant and has tested HIV positive. Which anti-retroviral drug should be avoided in women who are pregnant?
- Lopinavir/r
13. The cost of HIV treatment can be prohibitive for any patient. Patients can receive assistance from the:
1. Best Pharmaceuticals for HIV/AIDS Patient Act
2. Ryan White HIV/AIDS Treatment Modernization Act
3. National Institute of Health HIV/AIDS Assistance Fund
4. Centers for Disease Control HIV/AIDS Treatment Fund
14. Resistance to anti-retroviral therapy art is measured by:
- Determining plasma viral RNA on to success of measurements
15. Phenotype essays are used to measure what about anti-retroviral therapy?
- Sensitivity
16. Patient factors that contribute to antiretroviral therapy our failure include:
- Art adverse effects
17. Patients who are taking anti-retroviral therapy need to have the following monitored:
- Lipid levels
18. Successful anti-retroviral therapy art and an HIV positive patient is determined by:
- Individual measures of success based on their personal situation
19. The goal of treatment one prescribing anti-retroviral medication to patients with HIV include;
- Prevent vertical HIV transmission, improve quality of life, prolong survival
20. A challenge faced with anti-retroviral therapy (art )is:
- Drug resistant mutations of HIV
21. Predictors for successful treatment with anti-retroviral therapy art and HIV positive patients include:
- The patient is strictly adherent to the art treatment regimen
22. The goal of anti-retroviral therapy and HIV positive patients is
- Maximum suppression of HIV replication
23. Pregnant women who are HIV positive:
- Are treated with a combination anti-retroviral therapy art regimen
24. Anti-retroviral therapy is recommended for HIV positive patients with
- A history of aids defining illnesses, pregnant women, hepatitis B coinfection
25. Is considering starting a patient on the nucleo-side reverse transcriptase inhibitor abacavir, The following testing is recommended prior to prescribing:
- HLAB*5701 testing
26. Mild acne treatment - first line Tx options
- Topical antibiotics
o Benzoyl peroxide (BP)
- Topical retinoids
- BP or topical retinoid
- Combo Tx
o BP + antibiotic
o retinoid + antibiotic
o BP + retinoid + antibiotic
27. Moderate Acne Treatment
- Oral antibiotic
o Doxycycline drug of choice
- Comdedolytics
o Retinol and azelaic acid
- Hormonal agents
o Oral birth control (15 years and older)
- Spironolactone added to regimen when no response to other mediations
- must be on oral BC d/t teratogenic effects
28. Moderate acne treatment options
- Topical combo Tx options
o BP + antibiotic
o Retinoid + antibiotic
o Retinoid + BP + antibiotic
- OR
- Oral antibiotic + topical retinoid + BP
- OR
- Oral antibiotic + BP + topical antibiotic + topical retinoid
29. Severe acne treatment options
- Oral antibiotics
- +
- Topical combo therapy
o BP + antibiotic
o Retinoid + BP
o Retinoid + BP + antibiotic
- OR
- Oral Isotretinoin (Accutane)
30. Eczema
- Atopic dermatitis, leads to chronic inflammatory skin disease
- 1st line Tx
o Moisturizer
o Topical steroid
- cause skin atrophy, hyperpigmentation, red lesions, and w/ high dose adrenal suppression
- 2nd line Tx - Topical Immunosuppressants
o Tacrolimus
o Pimecrolimus
- only used in those who do not respond to topical steroids
- Risk for skin cancer and lymphoma
31. Key ingredient in organic sunscreen
- Avobenzone - only one that absorbs UVA1
32. Salicylic acid - patient teaching
- Topical keratolytic
33. Salicylic acid - adverse effects and patient teaching
- Systemic salicylate toxicity
- caused by long term use
- applied to areas other than face
- tinnitus
- hyperpnea
- n/v
- psychologic disturbances
- use in 12 +
34. Benzoyl Peroxide - adverse effects and patient teaching
- 1st line drug for mild - moderate acne
- Effects
o hypersensitivity reaction especially w/ a Hx of asthma
o peeling/drying of skin
o burning, blister, scaling, swelling
- reduce use
- Teaching
o use in 12+
o use in pregnancy
o DONT use w/ Dapsone - skin turns yellow
35. Isotretinoin - adverse effects
- Treatment of severe acne
- BBW
o causes structural/cognitive effects in developing fetus and increased risk of spontaneous abortion
- Effects
o nose bleeds
o eye swelling
o lip swelling
o dry, flaky skin
o muscle aches/pains
o depression/SI
o pseudotumor cerebri (increased ICP)
- Pediatric
o back pain and premature closure of growth plate
36. Isotretinoin - patient teaching
- affects night vision
- easily sunburn
- frequent blood tests (lipid/liver q 2 weeks)
- use 2 forms of BC
- can't donate blood
- avoid vit A
- avoid alcohol
- avoid waxing, laser, dermabrasion
- Notify MD
o HA, vision changes, vomiting, Sz = increased ICP
o Depression/SI
o ED
37. Brimonidine (a2-adrenergic agonist)
- First line topical drug for long-term treatment of glaucoma
- decreases IOP by reducing production of aqueous humor and increasing outflow
38. Brimonidine (a2-adrenergic agonist) - adverse effects
- dry mouth
- ocular hyperemia
- local itching, stinging, FB sensation
- HA,
- blurred vision
- Crosses blood-brain barrier
o drowsiness
o fatigue
o low b/p
39. Brimonidine (a2-adrenergic agonist) - patient teaching
- Absorbs into contact lenses
o wait 15 minutes before inserting contact lenses
o Monitor for CNS effects: drowsy/hypotension
o AVOID in <2 years old
o can cause orthostatic hypotension = fall risk
40. Prostaglandin analogs
- Lantanoprost
- Travoprost
- Bimatoprost
- Tafluprost
- Lantanoprostene bunod
- First line Tx of glaucoma by increasing aqueous humor OUTFLOW
41. Prostaglandin analogs - Adverse effects
- brown pigmentation of iris
- blurred vision
- eye discomfort
- ocular pruritis
- allergic conjunctivitis
- dry eye syndrome
- light intolerance
- tearing
- macular edema
42. Prostaglandin analogs - Patient Teaching
- AVOID in pregnancy
- NOT recommended in childrenV
43. Beta blocker use in treatment of glaucoma - B-1 & B-2
- Lower IOP by decrease production of aqueous humor
- topical route
44. B-1 cons in Tx of glaucoma
- block B-1 cardiac receptors
- cause bradycardia and atrioventricular block
- caution w/ Hx HF
- Contraindicated in AV block, sinus brady, and cariogenic shock*
45. B-1 Betaxolol
- ONLY B-1 selective BB used to treat glaucoma in patients with a history of COPD and asthma
46. B-2 beta blockers
- block B-2 receptors in the lung
- cause broncho constriction
- Contraindicated w/ a history of asthma or COPD**
47. Acute Otitis Media (AOM)
- Defined as infection, fluid, and inflammation in the middle ear
- S/S
o ear pain (otalgia) = pull/tug at ear
o fever, anorexia, irritability, sleepless, vomiting, diarrhea
o fluid causes tympanic membrane to bulge outward
48. Treatment of AOM when CERTAIN diagnosis
- 6 months = antibacterial therapy
- 6 months - 2 years = observational w/ unilateral AOM w/ mild symptoms w/out otorrhea (ear drainage)
- 2+ = severe = antibiotics, mild = observation
49. Tx of AOM when UNCERTAIN diagnosis
- 6 months = antibacterial therapy
- 6 months - 2 years = severe = antibiotic, mild = watch
- 2+ = observation regardless of symptoms
- Tx of AOM for 5+ years old Topical anesthetic ear drops
50. External Otitis Media (EOM)
- inflammation of external auditory canal
- Swimmers ear
- rapid onset of ear pain with associated itching, fullness, and tenderness with touch
- Cause
o abrasion or extra moisture
51. AOM antibiotic therapy
- Immediate and persistent s/s after 48-72 H (no Rx)
o non-severe = amoxicillin
o severe = amoxicillin/clavulanate
- Persistent s/s w/ Rx
o non-severe = amoxicillin + clavulanate
o severe = ceftriaxone x3 days IM
52. EOM treatment
- analgesics are necessary (very painful)
- keep ear as dry as possible
- same antibiotics used for AOM
- 2% solution of acetic acid and/or alcohol
- above 2 meds all needed at times
- Immediate and persistent s/s after 48-72 H (no Rx)
o non-severe = amoxicillin
o severe = amoxicillin/clavulanate
- Persistent s/s w/ Rx
o non-severe = amoxicillin + clavulanate
o severe = ceftriaxone x3 days IM
53. EOM treatment
- If infection extends beyond the EAC involving the pinna treat with Cipro
54. Otomycosis
- fungal infection of the ear
o Aspergillus
o Candida
- S/S
o itching, erythema, with or without pain/hearing loss
55. Otomycosis treatment
- - cleaning and acidifying drops = acretic acid solution 4x/day x7 days = clears infection
- Inadequate treatment above
- = topical anti-fungal = 1% clotrimazole
56. Treatment of non-extensive AOE not cleared with acetic acid or alcohol?
- Quinolones (Cipro) preferred treatment - highly effective, not ototoxic.
- Add steroid = decreased inflammation
57. How to manage rebound congestion
- Develops d/t progressive larger doses of topical sympathomimetics
- D/C on nostril at at time
- Use a intranasal glucocorticoid for 2-6 weeks, 1 week before d/c'ing decongestant
- Limiting use of topical med to 3-5 days
58. Expectorants
- Guaifenesin
- Mucinex
- Renders a cough more productive by stimulating flow of respiratory secretions
59. Intranasal Glucocorticoids
- Fluticasone propionate
- Most effective prevention and treatment of seasonal and perennial allergies!
- Prevent/suppress major symptoms of allergic rhinitis
- >congestion, rhinorrhea, sneezing, nasal itching, and erythema
60. Oral Sympathomemetic
- Pseudoephedrine
- Reduces nasal congestion associated w/ allergic rhinitis.
- NO effect on other symptoms
61. Oral Antihistamine Loratadine
- Reduces sneezing, rhinorrhea, nasal itching
- less effective than intranasal glucocorticoids
62. Intranasal Cromolyn Sodium
- extremely safe
- moderately useful for allergic rhinitis
- reduces symptoms by suppressing release of histamine and other inflammatory mediators from mast cells
- drug is best suited for prophylaxis, but effects develop after a week or two
- minimal ADRs
63. Treatment of nasal congestion
- Intranasal glucocorticoids
- Oral decongestant
64. Treatment of intermittent sneezing, nasal itching, rhinorrhea
- Oral antihistamine
- Intranasal antihistamine
65. Treatment of mild allergic rhinitis
- Oral antihistamine
66. Treatment of moderate/severe allergic rhinitis
- Intranasal glucocorticoid
- Intranasal antihistamine
- Combo therapy
67. Omalizumab
- Monoclonal antibody directed against IgE thus decreases release of inflammatory mediators from mast cells and basophils
- Tx allergy mediated asthma
68. Intranasal Glucocorticoids
- Budesonide
- Fluticasone
- Triamcinolone
- First line treatment and prevention of rhinitis due to anti-inflammatory response
69. Intranasal Glucocorticoids - ADVERSE EFFECTS
- Dry, burning, itching nasal mucosa
- Sore throat, nose bleeds, HA
- Slow growth in children
70. Intranasal Glucocorticoids - Patient teaching
- once symptoms are under control, reduce dose to lowest effective amount
- daily dosing most effective
- Seasonal rhinitis (environmental allergies)
o effects take up to 1 week
- Perennial rhinitis (dust dander/pets)
o effects take 2-3 weeks to develop
71. Montelukast (Singulair) a Leukotriene Antagonist
- Blocks leukotrienes (which cause nasal congestion) thus relieving nasal congestion
- Used for seasonal/perennial rhinitis
72. Montelukast (Singulair) - Adverse effects/patient teaching a Leukotriene Antagonist
- Serious neuropsychiatric effects
- agitation
- depression
- hallucinations
- insomnia
- SI
- reserved for those who can't take nasal steroids/antihistamines
- Teach
o only relieve nasal congestion
73. Sympathomimetics
- Phenylephrine
- Pseudoephedrine
- Activate vascular a1 receptors = vasoconstriction thus decreasing nasal congestion
74. Sympathomimetics - ADVERSE EFFECTS
- Oral - CNS effects
- restlessness
- insomnia
- increased BP
- Cardiovascular effects
o Hx of cardiac issues = hazardous
- Nasal
o rebound nasal congestion
75. Sympathomimetics - Patient teaching
- Only relieves nasal congestion
- Pseudoephedrine
o Not recommended in younger than 12 years
o Associated w/ misuse/abuse
- Phenylephrine
o Not recommended younger than 4 years
o Not used for more than 3-5 days
o Clean applicator after each use
o Admin drops w/ lateral, head low position [Show Less]