Drug Identification - NCLEX-PN

Fentanyl citrate comes in solid form on a stick (often referred to as a "fentanyl lollipop"). This form is 80-100 times more potent than morphine and intended for use by cancer patients and patients that have become tolerant to opioids.

Naloxone antidotes opioid overdose by competitively binding to μ-opioid receptors. Flumazenil is an antidote to benzodiazepines. Glucagon is an antidote for beta blocker overdose. N-acetylcysteine is an antidote for acetaminophen.

Acetaminophen in doses over 3000mg per day can result in significant liver damage or liver failure. From 1998 to 2003, acetaminophen was the leading cause of acute liver failure in the United States. According to a population-based report in 2007 there are an estimated 1600 cases of acute liver failure in the United States every year, with acetaminophen being the most common etiology.

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). These drugs work by inhibiting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), which reduces the synthesis of pro-inflammatory prostaglandins and thromboxane.

Levodopa (L-DOPA), a common treatment for Parkinson's disease, is generally given in combination with carbidopa or another peripheral dopa-decarboxylase inhibitor. This is because levodopa alone will stimulate dopamine receptors in the GI tract and the chemotrigger receptor zone (CTZ) in the brain, resulting in nausea, vomiting and anorexia. A peripheral dopa-decarboxylase inhibitor prevents levodopa from being prematurely converted into dopamine in the adrenal glands or other peripheral tissues.

Adalimumab is a tumor necrosis factor alpha (TNF-alpha) inhibitor. This class of drugs suppresses response to TNF-alpha, a potent pro-inflammatory cytokine. Inhibition of folic acid metabolism is the method of action of methotrexate. Reversible inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) is the mechanism of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Rheumatoid arthritis drugs such as rituximab, and almost all drugs that end in -mab, including adalimumab function as monoclonal antibodies.

The correct answer is "insomnia," as steroids are known to increase patients' vigilance and energy levels, thereby frequently making it difficult for patients to fall asleep and/or stay asleep while taking their steroid medication. The other choices are incorrect. Decreased appetite is not a side effect of taking steroid medications. Patients on steroids often have increased appetite. Hyponatremia and hyperkalemia both are not side effects of taking steroid medications. Hypernatremia and hypokalemia are more common side effects of steroids. Hypertension, rather than hypotension is a known side effect of steroid use.

Hepatotoxicity and potential liver failure are the most serious potential adverse effects of rifampin use. Patients on this medication must establish baseline liver function tests and be monitored for liver damage. None of the other conditions listed are associated with rifampin use.

Aminoglycoside antibiotics are used to treat Gram negative bacteria. They have not been shown to be effective against Gram positive bacteria and are not antifungal. Recall the major difference between the Gram negative and positive bacteria are their cell wall composition; Gram negative have a small proportion of peptidoglycan and a high proportion of lipopolysaccharide, while Gram negative bacteria have a large proportion of peptidoglycan.

The only aminoglycoside antibiotic among those listed is streptomycin. Other examples of aminoglycosides include tobramycin and gentamicin. All aminoglycosides either end in -mycin or -micin. However, this suffix is not exclusive to aminoglycosides. It is also seen in the macrolides: erythromycin and azithromycin and both macrolides, and in lincosamides such as clindamycin.

Aminoglycoside antibiotics such as streptomycin and gentamicin have been associated with vestibular toxicity and hearing loss. Aminoglycosides remain in inner ear fluids longer than serum and can have a latent ototoxic effect, causing hearing loss even after the antibiotic has been discontinued. None of the other antibiotics listed are associated with ototoxicity.

Ciprofloxacin belongs to the fluoroquinolone class of antibiotics. Other antibiotics in this class include norfloxacin, levofloxacin, and nadifloxacin.

Fluoroquinolones (the most commonly prescribed of which is ciprofloxacin) carry a risk of all of the following adverse effects: sudden tendon rupture or tendonitis, hepatotoxicity or liver failure, seizures, and permanent peripheral neuropathy. Other adverse effects include C_lostridium difficile_ associated diarrhea, bone marrow suppression, Steven-Johnson's Syndrome, tremors, and psychosis. The majority of these adverse effects are seen in higher numbers in children and the elderly.

Tetracycline antibiotics are contraindicated in pregnant women and small children due to their tendency to irreversibly stain developing teeth. They can also affect fetal bone growth and so are pregnancy category D (known incidence and risk of fetal harm).

Of the antibiotics listed, amoxicillin is the only one considered safe in pregnancy. Doxycycline and gentamicin are both pregnancy category D (known to cause fetal harm). Levofloxacin is category C (fetal harm can not be ruled out).

All of the drugs listed frequently cause C_. difficile_ overgrowth and C_. difficile_ associated diarrhea except vancomycin, which is often used as a treatment for persistent C_. difficile_ infections.

Penicillins belong to a larger class of antibiotics known as beta-lactams. These antibiotics inhibit cell-wall synthesis and are exclusively used to treat Gram positive bacteria. They are not effective against Gram negative bacteria or fungi.

Fluoroquinolones are considered to be the treatment of choice for E . coli infections due to their effectiveness in relieving diarrhea and minimal serious adverse effects. Aminoglycosides and beta-lactam antibiotics may also be effective, as a second choice.

Gentamycin, an antibiotic and aminoglycoside, inhibits protein synthesis of gram-negative bacteria. It treats severe systemic infections. It may cause ototoxicity and nephrotoxicity, as well as anorexia, nausea, vomiting, and diarrhea. Diaphoresis is not a common side effect of gentamycin.