NUR-641E Final Exam Study Guide Paper

NUR-641E Final Exam Study Guide Paper

Note: When taking the final exam, read each question carefully. The exam questions have only one answer, unless the question specifically states there is more than one correct answer.

Pharmacokinetics

1. Pharmacokinetics involves ADME (absorption, distribution, metabolism and elimination).
   1. Absorption: absorption from the administration site either directly or indirectly into the blood/plasma.
   2. Distribution: reversibly or irreversibly move from the bloodstream into the interstitial and intracellular fluid.
   3. Metabolism: biotransformed via hepatic metabolism or by other tissues.
   4. Elimination: Lastly, the drug and its metabolites are eliminated from the body. NUR-641E Final Exam Study Guide Paper
      

      PLACE YOUR ORDER HERE NOW

2. The route of administration with the highest bioavailability is intravenous; putting entire dose into a patient’s vein and bypassing absorption.
3. Intravenous route avoids first-pass metabolism in the liver.
4. Rectal administration has variable and erratic absorption.
5. Steady state (SS) is usually reached within 4-5 half-lives of a drug.
6. Half-life of a drug is how long it takes for half the drug to be excreted from the body.
   1. Determines how frequently the drug must be administered.
   2. Predicts how long toxic effects can last.
7. First-order (linear) pharmacokinetics means the metabolism is directly proportional to the free concentration of the drug .
8. Zero-order (nonlinear) pharmacokinetics means a drug is metabolized at a constant rate per unit time.
9. CYP3A4 substrate drugs may have decreased activity if any CYP3A4 inducer drugs are used along with it.

Drug Development

1. Drug development process involves these steps according to the FDA:
   1. Discovery: laboratory research to develop the new drug.
   2. Preclinical research with animal testing for safety.
   3. Clinical research on healthy human subjects to assess medication pharmacokinetics (Phase I).
   4. Clinical research in humans primarily for medication safety usually in a population for which the treatment is intended (Phase II).
   5. Clinical research in humans comparing the new drug to accepted medications or placebo for efficacy and safety (Phase III).
   6. FDA review of the results to determine approval.
   7. Postmarketing study to identify adverse effects not found in earlier clinical studies (Phase IV).
2. Medication safety organizations include the Food and Drug Administration (FDA), the Institute for Safe Medication Practices (ISMP), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
   1. The Institute for Safe Medication Practices (ISMP)
   2. The Institute of Medicine (IOM)
   3. The Joint Commission
   4. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)
   5. Food and Drug Administration (FDA) Safe Use Initiative NUR-641E Final Exam Study Guide Paper

Adverse Drug Reactions (ADRs)

1. Two basic type of ADRs: pharmacological and idiosyncratic.
2. 85% to 90% of ADRs are pharmacological.
3. Adverse drug reactions are usually preventable, frequently occur in a hospital or nursing home setting, and include medication errors, adverse drug effects, and allergic and idiosyncratic type reactions.
4. ADRs are not commonly reported; the FDA does not mandate that ADRs be reported.
5. Polypharmacy involves using multiple health care providers for care, using multiple medications, and using several pharmacies for prescription filling.

Cardiovascular

1. Angiotensin converting enzyme inhibitors (ACEIs): lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril.
2. ACEIs reduce blood pressure by suppressing the release of angiotensin-converting enzyme.
3. Important side effects of ACE inhibitors include cough and angioedema; discontinue the ACEI if angioedema occurs.
4. Angiotensin II receptor blocking agents (ARBs): candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).
5. ARBs reduce blood pressure by blocking angiotensin II receptors.
6. Essential (primary) hypertension accounts for 90% of cases; secondary hypertension may be caused by chronic renal failure.
7. Nitroglycerin is a nitrate drug that can be administered IV, SL, as a topical ointment, and as a transdermal patch.
8. Nitrates are contraindicated with PDE-5 inhibitors (e.g., sildenafil and vardenafil)NUR-641E Final Exam Study Guide Paper.
9. Amiodarone is the antiarrhythmic of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity.
10. Alpha-1 adrenergic stimulation results in vasoconstriction and increased blood pressure.
11. Alpha-1 adrenergic blockade results in vasodilation and reduced blood pressure.
12. Beta-1 adrenergic stimulation by beta agonists (e.g., isoproterenol) results in increased heart rate, increased blood pressure, and increased cardiac output.
13. Beta-1 adrenergic blockade results in reduced heart rate, reduced blood pressure, and reduced cardiac output.
14. Left heart failure causes reduced delivery of oxygenated blood to the body tissues.
15. Right heart failure is associated with pulmonary disease and increased pulmonary vascular resistance.
16. A drug that relieves heart failure symptoms but does not reduce mortality is furosemide.
17. Loop diuretics like furosemide are potent diuretics, can cause diuretic resistance and hypokalemia, and work on receptors in the thick ascending renal loop of Henle.
18. Loop diuretics inhibit the reabsorption of sodium and chloride at this site in the kidney.
19. Potassium-sparing diuretics: spironolactone, triamterene.
20. Milrinone is a phosphodiesterase inhibitor used for acute heart failure.
21. Children diagnosed with the tetralogy of Fallot can stop hypoxic spells by squatting down (a compensatory mechanism)NUR-641E Final Exam Study Guide Paper.
22. Patent ductus arteriosus (PDA) is a congenital heart defect with a continuous machine-like murmur heard over the left upper sternal border in both systole and diastole, a bounding pulse and a thrill on palpation.
23. PDA can be effectively treated with IV NSAIDs such as indomethacin.
24. Raynaud’s disease is a vasospastic disorder typically seen during cold weather.
25. Raynaud’s involves the small arteries and arterioles in the fingers; occasionally, the toes are also involved.
26. Raynaud’s is treated with dihydropyridine-type calcium channel blockers (e.g., nifedipine) because they cause peripheral vasodilation.

Respiratory

1. Asthma is an obstructive airway disease associated with airflow obstruction, mucus production, hyperreactivity of the bronchial tissue, and inflammation.
   1. Mild persistent asthma is best treated with a short-acting beta-2 agonist (SABA) plus an inhaled corticosteroid.
   2. Moderate persistent asthma is best treated with an inhaled low-dose corticosteroid and a long-acting bronchodilator.
   3. Severe persistent asthma is best treated with a long-acting beta-2 agonist (LABA), plus a high-potency inhaled corticosteroid, plus an oral corticosteroid drug.
2. Inhaled short-acting beta-2 agonists (SABA) are indicated only for PRN use.
3. Long-acting beta-2 agonists (LABA, e.g., salmeterol) should never be used in an acute asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol).
4. Short-acting beta-2 agonists (SABA) are used in acute asthmatic attacks, but can increase heart rate, tremors, nervousness, and reduce serum potassium levels.
5. Instruct a patient on any inhaled corticosteroid product to rinse the mouth after each use of the inhaled corticosteroid product.
6. Advair (fluticasone and salmeterol) is an example of a long-acting beta agonist and a corticosteroid.
7. Anoro ellipta (umeclidium/vilanterol) is an example of a long-acting beta agonist and an anticholinergic agent.
8. Combivent (albuterol/ipratropium) is an example of a short-acting beta agonist and an anticholinergic agent.
9. Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is used once a day in asthma and COPD.
10. Cystic fibrosis (CF) is a pulmonary disorder typically seen in childhood, with an increased production of a protein-producing thick mucus that blocks the airways, pancreatic ducts, sweat gland ducts, and vas deferens.
11. CF of the pancreas is also known as fibrocystic disease of the pancreas.
12. Respiratory distress syndrome is a lung disorder characterized by increased pulmonary resistance and caused by a surfactant deficiency.
13. Transudative pleural effusions have watery and diffuse fluid due to increased blood pressure or decrease capillary oncotic pressure.
14. Cystic fibrosis is associated with meconium ileus.

Musculoskeletal

1. NSAIDS have anti-inflammatory, analgesic, and antipyretic activity.
2. Acetaminophen has analgesic and antipyretic activity, but not anti-inflammatory activity.
3. The NSAID considered safe to use by individuals with heart disease is naproxen.
4. Gout is treated with antigout drugs (e.g., allopurinol, colchicine, febuxostat) and uricosuric drugs (probenecid, sulfinpyrazone)NUR-641E Final Exam Study Guide Paper.
5. The only drugs that directly work on the pathophysiological causes of gout are allopurinol and febuxostat.
6. Renal calculi can occur as a comorbid condition in patients with gout.
7. Colchicine reduces the inflammatory response seen in gout, reduces the pain in an acute gout attack, but does not stop gout from developing into chronic gouty arthritis.
8. Colchicine efficacy is affected by its incidence of adverse effects.
9. Allopurinol is the only drug that inhibits xanthine oxidase.
10. Urate lowering therapy (ULT) can initiate an acute gouty attack; concomitant colchicine, NSAIDS, or corticosteroids are used with ULT drugs to decrease the incidence of ULT-induced acute gouty attacks.
11. Allopurinol is the agent of choice for individuals with gout and high serum urate levels with underlying renal dysfunction, history of tophaceous gout, or urinary calculi.
12. Acute gouty attacks are treated preferentially with NSAIDS (e.g., indomethacin, ibuprofen, naproxen, sulindac).
13. NSAIDs can cause GI bleeding (indicated by darkening of stools and epigastric pain); one recommendation is switch to a COX-2 inhibitor (i.e., celecoxib).
14. Ankylosing spondylitis is a chronic inflammatory joint disease characterized by fusion and stiffening of the spine and sacroiliac joints.
15. Acute liver disorders (e.g., acute hepatitis, hepatotoxicity) may be caused by acetaminophen overdose.
16. Osteoblast cells on bone cause bone formation; osteoclasts are cells on bone that cause bone breakdown.
17. Osteomalacia is a condition of insufficient bone mineralization (softening of bone).
18. Osteoporosis is a metabolic disorder with reduced bone mass/density.
19. Osteosarcoma is cancer of the bone and is most commonly diagnosed in childhood.
20. Paget’s disease is a disorder in which abnormal new bone growth occurs at a faster rate than normal, involving increased resorption of spongy bone tissue.
21. A pathologic fracture is a fracture occurring at the site of a pre-existing bone abnormality and occurs with a force that is considerably less than that which would cause a bone fracture at a different site.
22. In osteoporosis, estrogen exerts antiapoptotic effects on osteoblasts and proapoptotic effects on osteoclasts.
23. Myofascial pain syndrome is the result of muscle spasms, tenderness, and stiffness and leads to muscle guarding that limits muscle motion.
24. Dystrophin is absent in muscle cells of patients with Duchenne muscular dystrophy.

Fluid and Electrolytes

1. Antidiuretic hormone (ADH) is synthesized in the hypothalamus and causes the reabsorption of water in the distal tubule and collecting duct of the kidney.
2. An essential treatment for hyponatremia is normal saline IV (0.9%NaCl).
3. Orthostasis can be a significant side effect with use of a diuretic drug.
4. Orthostatic hypotension is defined as a decrease of >20mmHg systolic blood pressure or a decrease of >10mmHgdiastolic blood pressure within 3 minutes of assuming a standing position.
5. Causes of hyperkalemia: high potassium intake, renal insufficiency, systemic lupus erythematosus, Addison’s disease, use of potassium-sparing diuretics.
6. Treatment of hyperkalemia include calcium gluconate, loop diuretics, patiromer (Veltassa), thiazide diuretics, sodium polystyrene sulfonate (Kayexalate), regular insulin IV, and inhaled albuterol.
7. Insulin and beta-2 agonist inhalers are used to treat hyperkalemia because they move potassium from the bloodstream into the cells; insulin also increases the transport of glucose from the bloodstream into the cells.
8. Calcium and phosphate homeostasis is affected by parathyroid hormone, vitamin D, and calcitonin.
9. Hypercalcemia causes: bone hyperplasia, neoplasms, and thiazide diuretics.
10. Hypercalcemia treatments: calcitonin, pamidronate, zoledronic acid.
11. Insufficient dietary intake of vitamin D can result in cardiovascular disease, osteoporosis, and rickets.
12. Insufficient dietary intake of vitamin B12 can result in pernicious anemia.
13. A patient with metabolic acidosis and partial respiratory compensation will have symptoms of fatigue, cool pale hands and feet, a new-onset systolic heart murmur, and vomiting coffee-ground looking material.
14. Hypokalemia will increase digoxin toxicity. NUR-641E Final Exam Study Guide Paper
    

    ORDER HERE NOW

Endocrinology

1. Hyperparathyroidism can cause secondary renal failure.
2. Primary hyperparathyroidism is typically caused by a tumor in the parathyroid gland.
3. Hyperglycemia can occur with increased release of cortisol, epinephrine, glucagon, and growth hormone into the bloodstream.
4. Hypoglycemia can be caused by starvation and intense exercise.
5. A patient with type 1 diabetes who exercises heavily may have symptoms of hunger, headache, lightheadedness, confusion, tachycardia, and pallor due to hypoglycemia.
6. Obesity is a risk factor for developing type 2 diabetes because of increased insulin resistance.
7. Glucagon stimulates glycogenolysis by the liver.
8. Dawn phenomenon (dawn effect) occurs in the early morning hours (i.e., between 2 a.m. and 8 a.m.); blood glucose levels increase in patients with diabetes. There is not nighttime hypoglycemia.
9. Somogyi effect occurs after an episode of untreated nighttime hypoglycemia, causing increased blood glucose levels in the morning; treated by increasing food intake near bedtime or reducing the evening insulin dose.

Gastrointestinal:

1. Laxatives: stimulants (e.g., senna, Bisacodyl, magnesium oxide [milk of magnesia], magnesium citrate, castor oil), bulk (psyllium, methylcellulose), stool softeners (e.g., docusate), sugars (e.g., lactulose), osmotic agent trapping water in the GI lumen (e.g., polyethylene glycol), mineral oil.
2. Linaclotide (Linzess) for chronic idiopathic constipation (CIC).
3. The safest laxative for chronic use is methylcellulose (Citrucel, Metamucil).
4. Octreotide is a potent vasoconstrictor used in treating acute GI bleeds.
5. Antiemetic agents: antihistamines, phenothiazines (e.g. prochlorperazine), 5HT3 receptor antagonists (e.g., ondansetron [Zofran], granisetron)NUR-641E Final Exam Study Guide Paper.
6. Ondansetron can cause constipation, headache, and heart conduction irregularities (prolonged QT interval).
7. 5HT3 receptor antagonists inhibit serotonin receptors inside the chemoreceptor trigger zone (CTZ) and inhibit serotonin receptors on vagal nerve terminals; these pharmacologic actions reduce nausea and vomiting.
8. H2RAs: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid).
9. Lactulose is used in hepatic encephalopathy; works by ion trapping of ammonia.
10. Proton pump inhibitors (PPIs): esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex).
11. Heart patients taking clopidogrel (Plavix) should avoid omeprazole; it blocks enzymatic conversion of clopidogrel to its active metabolite.
12. Clopidogrel does not interact with pantoprazole, rabeprazole, or lansoprazole.
13. Overuse of PPIs can result in Clostridium difficile infection (CDI).
14. Adverse effects of opioid analgesic agents include constipation, addiction, overdose, sedation, and impaired daily functioning.
15. Docusate, a stool softener, is the preferred laxative for prophylaxis of opioid-induced constipation (OIC).
16. Gluten-sensitive enteropathy (celiac sprue) is an autoimmune disorder of the small intestine in which the affected patient cannot absorb certain cereal proteins.
17. Dumping syndrome (rapid gastric emptying) can occur after a partial gastrectomy and has symptoms of rapid pulse, hypotension, pallor, weakness, sweating, and faintness.
18. Dumping syndrome can cause a high osmotic gradient in the small intestine, resulting in a rapid movement of fluid from blood vessels into the intestinal lumen.
19. The liver is the one internal organ that can regrow back to its original size depending on the area of tissue removed; this is a type of compensatory hyperplasia.
20. Vitamin B12 deficiency can occur after a partial gastrectomy; this may cause the patient to develop a pernicious anemia.
21. Know the characteristics of congenital aganglionic megacolon.
22. Know the characteristics of Hirschsprung’s disease
23. Know the characteristics of Periduodenal band. NUR-641E Final Exam Study Guide Paper

Hematology

1. UFH: unfractionated heparin.
2. LMWH: (low molecular weight heparin) enoxaparin (Lovenox); inhibits factor Xa.
3. Heparin produces rapid anticoagulation by binding with antithrombin III, and inhibits factors IXa, Xa, XIIa, and XIII.
4. Monitor heparin with aPTT (low dose SC heparin [5000 units BID] does not require aPTT monitoring).
5. Warfarin inhibits vitamin K-dependent blood factors II, VII, IX and X; takes several days for its anticoagulant effect.
6. Monitor the International Normalized Ratio (INR) when warfarin is used.
7. Blood factor IIa inhibitor (direct thrombin inhibitor): dabigatran (Pradaxa).
8. An antidote to dabigatran-induced hemorrhage is idarucizumab.
9. Blood factor Xa inhibitors: apixaban (Eliquis), edoxaban (Savaysa), rivaroxaban (Xarelto), fondaparinux (Arixtra).
10. Eptifibatide binds to GPIIb/IIIa receptor sites on platelets.
11. One symptom of hemolytic anemia is jaundice, caused by the destruction of heme that is greater than the hepatic conjugation and excretion of bilirubin.
12. Jaundice can be caused by hemolytic anemia, sickle cell anemia, pancreatitis, cholecystitis, and multidrug therapy used to treat pulmonary tuberculosis.
13. Erythropoietin is a substance manufactured in the kidney; the anemia of chronic renal failure reduces erythropoietin production and should be used to correct the anemia of chronic renal failure.

CNS/Neurology/Psychiatry

1. Sumatriptan is the only triptan available as an injection as well as tablets and a nasal spray.
2. Sumatriptan and zolmitriptan are the only triptans available as nasal sprays.
3. Intravenous anesthetics: ketamine, thiopental, fentanyl, propofol, dexmedetomidine.
4. Propofol has a rapid onset, does not usually cause nausea, and poor analgesia.
5. Propofol can affect triglycerides; monitor triglyceride levels.
6. ICU delirium commonly occurs in elderly patients, is treated with haloperidol, although dexmedetomidine (Precedex) is the preferred drug for sedation in the elderly.
7. If respiratory depression is a concern, dexmedetomidine (Precedex) is the preferred anesthetic; however, it should not be used longer than 24 hours, per the FDA-approved product information.
8. Selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), vortioxetine (Trintellix)NUR-641E Final Exam Study Guide Paper.
9. Side effects of SSRIs include weight gain, decreased sexual libido, and insomnia.
10. Olanzapine, a second-generation antipsychotic, has the advantage of being available as a long-acting injection for acute psychotic reactions.
11. Drugs most effective in alcohol withdrawal are lorazepam (Ativan) and phenobarbital; if liver dysfunction is present, lorazepam is the preferred agent because of its different metabolic pathway than other benzodiazepines.
12. All benzodiazepine drugs (e.g., diazepam, lorazepam, clonazepam, midazolam) can increase falls in the elderly and other people unsteady on their feet.
13. Drugs acting on the sympathetic nervous system include epinephrine, norepinephrine, dopamine, and dobutamine.
14. Drugs acting on the parasympathetic nervous system include atropine, oxybutynin, and ipratropium.
15. Arachnoid villi absorb excess cerebrospinal fluid (CSF) that accumulates in the cerebral venous sinuses that surround the brain; the villi maintain normal CSF volume and pressure.
16. The circle of Willis supplies collateral blood flow to the brain.
17. The adrenal medulla will increase secretion of the catecholamines epinephrine and norepinephrine due to sympathetic stimulation caused by increased stress.
18. Antidiuretic hormone (ADH) is synthesized in the hypothalamus and acts on the renal tubular cells.
19. Low levels of antidiuretic hormone (ADH) can cause diabetes insipidus (DI).
20. Diabetes insipidus (DI) patients have a laboratory finding of low urine specific gravity.
21. Multiple sclerosis is a disorder involving the demyelination of CNS nerve fibers (central component of the pathological model).
22. Alzheimer’s disease (AD) is the development of neurofibrillary tangles in the CNS.
23. Know the functions that match to the appropriate cranial nerve.
24. Deafferentation pain results from damage (e.g., from trauma or disease) to a peripheral nerve.
25. Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system.

Antiepileptic Agents

1. Roughly 10% of the U.S. population may experience at least one seizure during their lifetime.
2. Epilepsy is the fourth most common neurologic disorder (after migraine, cerebrovascular disease, and Alzheimer’s disease).
3. Several mechanisms involved in seizure activity, but all have swift, excessive, and synchronous discharge of cerebral neurons.
4. Generalized seizure types include tonic-clonic (grand mal), absence (petit mal), clonic, myoclonic, tonic, and atonic; there is loss of consciousness and no memory of the event.
5. Antiepileptic drugs reduce seizure activity by reducing sodium and/or calcium influx into brain cells, increasing the inhibitory gamma-amino butyric acid (GABA) activity, enhancing the influx of chloride, and interfering with excitatory glutamate transmission.
6. Antiepileptic drugs suppress seizure activity; they do not cure epilepsy.
7. Phenytoin is highly plasma protein bound, and serum levels should be interpreted according to the patient’s serum albumin level.
8. Antiepileptic agents have many drug interactions, are therapeutically monitored by measuring blood levels, and are not totally safe to use in a pregnant patient. NUR-641E Final Exam Study Guide Paper

Infectious Diseases

1. Penicillins, cephalosporins, carbapenems, and other beta-lactam antibiotics inhibit bacterial cell wall synthesis and integrity.
2. Tetracycline, macrolide, azalide, and aminoglycoside antibiotics inhibit specific bacterial proteins.
3. Empiric antimicrobial therapy is based on the patient’s history and the site of infection when susceptibility data are not available.
4. The primary cause of antimicrobial resistance is the indiscriminate use of antibiotic agents.
5. Cross-resistance seen with penicillin and cephalosporin drugs can occur because both antibiotic classes have a beta-lactam ring that the enzyme beta-lactamase from an organism can attack and destroy, rendering the antibiotic ineffective vs. the organism.
6. Antibiograms are charts of local antimicrobial resistance patterns developed by local laboratories.
7. Clostridium difficile (C. difficile) is the organism producing a toxin that causes antibiotic-associated pseudomembranous colitis (AAPMC). This type of diarrhea occurs often with clindamycin use.
8. Individuals with glucose-6 phosphate dehydrogenase (G6PD) deficiency have increased side effects when given sulfonamide drugs; avoid their use in these individuals.
9. Isoniazid (INH) is used in combination to treat tuberculosis, and vitamin B6 (pyridoxine) is administered with INH to reduce the side effect of peripheral neuropathy.
10. Tetracycline hydrochloride can cause stunted growth in children and should not be used; however, doxycycline and minocycline are safe for adolescent patients to use.
11. Short-term tetracycline therapy in a woman taking oral contraceptive drugs requires a secondary birth control measure (e.g., condom use) until the next menses.
12. Current guidelines state that adult heart patients undergoing dental procedures do not require prophylactic antibiotics.
13. Right-sided infective endocarditis due to staph aureus should be treated with daptomycin.
14. Pyrogenic bacteria produce endotoxins which stimulate release of inflammatory mediators that result in fever.
15. The invasion period is the stage of an infection when the immune and inflammatory responses are initiated.
16. Vertical transmission is the transmission of organisms across the placental barrier from mother to baby.
17. Horizontal transmission is the transmission of organisms from one person to another, typically through direct contact.
18. Passive-acquired immunity occurs with the passage of immunoglobulin across the placental barrier.
19. Combinations of beta-lactam antibiotics with beta-lactamase inhibitors increase the antimicrobial spectrum of activity of the beta-lactam antibiotic:

1. 1. Amoxicillin + clavulanic acid (Augmentin)
   2. Piperacillin+ tazobactam (Zosyn) for Pseudomonas
   3. Ampicillin + sulbactam (Unasyn)
   4. Ceftriaxone + sulbactam

20. Fluoroquinolones: Use is reserved for pneumonias or exacerbations of chronic bronchitis to decrease the potential for development of further resistance.
21. Delafloxacin is the only fluoroquinolones with activity against MRSA .
22. Fluoroquinolones interact with metals (e.g., iron, calcium, magnesium) in foods and vitamins; space dosing away from meals containing these metals.
23. Fluoroquinolones interact with dairy products and other calcium- and magnesium-containing products.
24. Fluoroquinolones may increase warfarin’s anticoagulant effect and decrease caffeine clearance (cause nervousness)NUR-641E Final Exam Study Guide Paper.
25. Monitor patients taking fluoroquinolones for joint pain; tendon rupture has been reported with these antimicrobial agents.
26. Fluoroquinolones may cause phototoxicity.
27. Cotrimoxazole (trimethoprim-sulfamethoxazole) is a good first-line antibiotic agent for UTI treatment in reasonably healthy individuals not previously taking antibiotics.
28. Elderly patient with a UTI may have disseminated abdominal discomfort and be quite confused.
29. The most common bacterial organism causing uncomplicated urinary tract infections is Escherichia coli, a gram-negative aerobic rod.
30. Use of Amphotericin B requires close monitoring of renal function (can cause nephrotoxicity) and hearing (can cause ototoxicity).
31. Metronidazole and oral vancomycin are used to treat C. difficile infection.
32. Patients taking metronidazole should not drink alcohol during therapy and abstain for at least two days after the therapy course is completed.
33. Fluconazole is highly active vs. Candida species (also many drug interactions – hepatic enzyme inhibition).
34. Ketoconazole requires careful monitoring of hepatic enzymes (ALT, AST, alkaline phosphatase), and bilirubin.
35. A fungal nail infection is called onychomycosis.
36. Tinea capitis is a fungal skin infection located on the scalp; tinea corporis is a fungal infection located on the trunk.
37. Activation of the complement system is responsible in large part for the destruction of pathogens by neutrophils and macrophages.
38. Eosinophils serves as the body’s primary defense against parasites.
39. IgM antibodies constitute the major component of the natural antibodies and is also the first class of antibodies produced during a primary immune response.
40. Eosinophils are activated during IgE-mediated hypersensitivity reactions.
41. Know the common autoimmune diseases.
42. Epstein-Barr virus is responsible for infectious mononucleosis.
43. Varicella zoster virus of childhood may resurface as herpes zoster years later in adulthood.
44. Impetigo is particularly infectious among people living in crowded conditions with poor sanitary facilities or in settings such as daycare facilities.
45. Kaposi sarcoma is caused by the human herpes virus type 8.

Dermatology

1. Psoriasis or seborrheic and actinic keratoses all have characteristic elevated, firm, and rough lesions that have a flat top surface > 1 cm in diameter.
2. Retinoids are vitamin A derivatives used to treat acne, psoriasis, and photoaging.
3. All retinoids can cause dry skin, skin irritation and peeling, a reddened skin area, and photosensitivity.
4. Oral isotretinoin is contraindicated in pregnancy because of a very high risk of birth defects.
5. Topical tazarotene is used for both acne and psoriasis.
6. Azelaic acid is used to treat mild to moderate inflammatory acne, with minor skin irritation.
7. Koplik spots are white spots that are surrounded by red ring/circle, are found on the buccal mucosa and are associated with rubeola.
8. A common sign of an allergic reaction is generalized urticaria.
9. Eczema is an inflammatory skin disorder also known as dermatitis and characterized by itching (pruritus) and lesions with indistinct borders.
10. A wart (lichen planus or verruca) is a skin condition with elevated and firm circumscribed lesions < 1 cm in diameter.
11. Adverse topical corticosteroid effects include thinning of the skin, dermatitis, striae, purpura, local skin infections, and hypopigmentation.
12. Potent topical corticosteroids (i.e., group I agents) should not be used over a large surface area in children because of hypothalamic-pituitary-adrenal axis suppression, growth retardation, and systemic toxicity.
13. Wet gangrene is associated with liquefactive necrosis of the skin.
14. Individuals with systemic lupus erythematosus (SLE) often have a red butterfly-shaped rash across their face.
15. SLE is a disorder caused by the deposition of circulating immune complexes containing an antibody that attacks the host DNA, resulting in tissue damage. NUR-641E Final Exam Study Guide Paper

Genitourinary

1. A recurrent UTI is an infection that is caused by different organisms; a relapsing UTI is an infection caused by the same organism; recurrent UTIs are seen more frequently than a relapsing UTI.
2. A male with a past occurrence of cryptorchidism has an increased risk of developing testicular cancer.
3. Testicular cancer typically occurs in young men between age 15 and 35 years of age.
4. Elderly men with underlying medical conditions, such as benign prostatic hypertrophy (BPH), should avoid drugs that have high anticholinergic activity (e.g., diphenhydramine).
5. Testicular torsion is the rotation of a testis, resulting in twisting of spermatic cord blood vessels.
6. A cause of male infertility is a varicocele, which results in low sperm count.
   

   ORDER NOW

7. Varicocele is an abnormal dilation of the vein inside the spermatic cord.
8. Intussusception causes intestinal obstruction by telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply.
9. Systemic hypotension, hemorrhagic blood loss, and hypovolemia may cause prerenal injury. NUR-641E Final Exam Study Guide Paper