Ep #153: NP Exam Pharmacology Lightning Session with Courtney H

Welcome to the Real Deal Nurse Practitioner Club, the podcast for nurses who are ready to pass their boards and thrive in their careers as real deal nurse practitioners. I’m Anna and I’m the Director of Nursing Content at Blueprint Test Prep. Whether you’re deep in exam prep or stepping into practice, I’ve got you. It is time to become the confident, knowledgeable NP that you’re meant to be. Let’s dive in. 

Hey everyone and welcome back. This is Anna and today I am joined by our wonderful content guru Courtney. And in line with our Pharmacology November theme we’ve got going on, we have a really fun episode planned for you all today.

Courtney: Yes, we are diving into some rapid fire pharmacology. We are just going to be doing some Q&A with each other that is quick, high yield, and to the point. And really this will simulate our one-to-one readiness sessions and how they work a little bit.

Anna: Yeah, absolutely. Do you want to elaborate on what that one-on-one readiness session is before we get started?

Courtney: For sure. Our one-to-one readiness sessions are an hour-long session between a student and one of our amazing NP instructors. They will go over when your test date is, how you have been prepping, and then they will do some quizzing back and forth over really high yield topics, both pharmacology and non-pharmacology related, customizing the session to you. 

A lot of students want to be quizzed over a little bit of everything, but some really do want to focus in on specific areas. And then at the end of the session, the instructor can give you some really good guidance on if you are ready to test on your planned test date. And then guidance on what to be doing and how to study in between now and then and answer any other questions you may have.

Anna: Yeah, and I know it seems a little intimidating when we say you’re being quizzed, but these are super encouraging. They’re really low key, and most actually find it to be really confidence boosting. 

Okay, before we start, I’m just going to do my quick disclaimer for this episode. What we are covering today, it is just strictly for study purposes. We are touching on textbook answers. We’re touching on key exam concepts here. There is so much more to be familiar with clinically and even for the exam, like drug interactions, boxed warnings, second line treatments. And we go way deeper into those in our full SMNP courses. But today, we only have so much time, so we can only cover some of the surface level content in this quick podcast episode.

I’m going to be asking the questions and Courtney is going to be answering for you all. And we’ll try to do a few pauses throughout so that you can think of the answer in your head if you’re quizzing yourself at home or in the car listening to this. All right, you ready?

Courtney: Let’s go. Hit me with your best pharm questions.

Anna: And one final caveat before we jump in. I’m going to do these in a somewhat organized fashion where I tell you the topic that we’re starting with, and we’ll do a couple all in the same category. So we’ll start with some antibiotics and then we’ll do some skin pharm. 

And I really find that helpful when we’re studying. But remember, your exam is all over the place and you never know what you’re going to get. So sometimes in those true one-on-one readiness sessions, we jump around just like your exam does.

But first one here, we’re going to start with some antibiotics. What are, Courtney, the first-line antibiotics, there’s about three of them I’m thinking of, so the three first-line antibiotics for uncomplicated urinary tract infections?

Courtney: All right. So that’s going to be nitrofurantoin or Macrobid, trimethoprim-sulfamethoxazole or Bactrim, and fosfomycin.

Anna: You are rocking those pronunciations.

Courtney: Woo! Sweating there.

Anna: And I always—like, you are not tested on the pronunciation. So if you can’t say them like that, no big deal.

All right, now let’s say a patient has an uncomplicated urinary tract infection, but they are on warfarin. Does that change any of those options for you?

Courtney: Absolutely. Avoid Bactrim. This medication plus warfarin increases the bleeding risk significantly.

Anna: Yep. Remember Bactrim is a sulfa drug and so you never want sulfa plus warfarin together.

Now, if you listened to our last episode over pharmacology all about antibiotics, you’ll probably remember this. But what is the preferred antibiotic after like a dog or a cat bite?

Courtney: For sure. That’s going to be amoxicillin-clavulanate or Augmentin. So remember, dog bitten Augmentin.

Anna: Absolutely. I love that little memory trick. We love our memory tricks here.

All right, let’s switch gears a little bit. We’re going to do a couple questions on STI-related pharm and then probably like a skin infection question. So what is the first-line treatment for gonorrhea?

Courtney: That’s going to be single-dose IM ceftriaxone.

Anna: Yes, absolutely remember that IM piece. And Courtney, do we co-treat for chlamydia if it hasn’t been ruled out?

Courtney: For sure. We’re going to add doxycycline there.

Anna: Yes, absolutely. What if it has been ruled out?

Courtney: Then we don’t need to treat it.

Anna: Yep. And you already said this, but let’s say they just have chlamydia by itself, what’s the first-line antibiotic?

Courtney: Doxycycline. However, if for some reason the patient can’t take doxycycline, you can use azithromycin as an alternative.

Anna: Absolutely. Again, remember those alternative antibiotics. Those love to be asked about on the exam. Okay.

Courtney: Yes, they do.

Anna: Let’s do a skin question. We talked about this one in our last episode too, but to refresh, for MRSA-related cellulitis, what’s your first-line?

Courtney: Bactrim, always. Doxycycline and clindamycin are the other options.

Anna: Absolutely. And what’s that big risk speaking of clindamycin? So what’s the big risk with that one specifically?

Courtney: That’s going to be a C. diff infection. You can pair the Cs with clindamycin and C. diff. You always need to educate your patients about this in advance.

Anna: Yeah, absolutely.

Let’s shift gears again. And I want to do one that loves to pop up on the exam related to women’s health. What is the recommended treatment for mastitis? And do we need to continue or hold breastfeeding with that?

Courtney: For sure. So the recommended treatment is dicloxacillin, but clindamycin or cephalexin, Keflex, are good alternatives, and you absolutely continue breastfeeding. 

Anna: Yeah. Do not stop breastfeeding. I actually had mastitis recently and it was miserable. But do not stop breastfeeding and make sure that infection fully resolves. Okay. Now we’re going to move into a couple respiratory related questions. So what are first-line antibiotics for community-acquired pneumonia in a healthy patient without comorbidities?

Courtney: Yes. So the key here is that this patient does not have comorbidities and is otherwise healthy. So in this scenario, amoxicillin is our go-to. Doxycycline will work, or a macrolide like azithromycin, but that is really dependent on local resistant rates.

Anna: Yeah, a lot of places are going away from azithromycin just because antibiotic resistance is so high there. Now, what if they did have major comorbidities or say they’ve taken antibiotics recently?

Courtney: For sure. So we’re going to need to use some heavy hitters here. So we step it up to Augmentin plus doxycycline or azithromycin or we can use a respiratory fluoroquinolone like levofloxacin.

Anna: Awesome. Yep, yep. All right. Now shifting it, this is still respiratory related but not pneumonia related. What antibiotic can turn body fluids like red or red orange?

Courtney: That’s going to be rifampin. And when you see it, you’ll never forget it and you’re going to want to educate patients about this so they don’t absolutely panic when their urine or even their tears change color.

Anna: It’s like red or brick orange. Often we see that rifampin used with like tuberculosis, but yes, always, always patient education on that one or you will get panicked phone calls.

All right, let’s talk about some herbal supplements because the exams really love these. And that’s actually why we have an entire course video dedicated to herbal supplements as well. But with herbal supplements, what’s really our biggest education point overall?

Courtney: For sure. The patients need to disclose them. They need to tell us that they are taking them because these supplements can interact with a lot of prescription medication.

Anna: Yeah. And sometimes you have to get creative on how you’re asking patients what they’re taking. So instead of just saying like, what medications are you taking, you can ask them, are you taking anything over the counter? What about any supplements? What about any herbal treatments? Because when you just ask what they’re taking, a lot of times they’ll forget to mention these.

Now, what is St. John’s wort used for?

Courtney: The patients will use this for depression. Now keep in mind, if they are taking any serotonergic agents like SSRIs or SNRIs, they should not be taking St. John’s wort because this increases the risk of serotonin syndrome significantly.

Anna: Yes, and that is absolutely a medical emergency. And another little caveat here with herbal supplements. All of these have so many uses that you will see in practice. We are just covering the main uses that are tested on on your certification exam. So what about ginkgo?

Courtney: Patients use this one for memory and cognition. But again, this is another one that increases the bleeding risk, especially in patients who take anticoagulants.

Anna: Yep. And then one more here. What about saw palmetto?

Courtney: Patients use that for benign prostatic hyperplasia or BPH.

Anna: All right, I think we have time for one more little section here. So let’s touch on some endocrine-related ones. We haven’t done any of those and then maybe I’ll throw in a mental health question too. So what’s first-line treatment for hypothyroidism?

Courtney: Before I dive into this, this is so, so important to know for your exam. And so that’s going to be levothyroxine or Synthroid. Other key teaching points there are that it has to be taken on an empty stomach with water 30 to 60 minutes prior to breakfast.

Anna: Perfect. Absolutely. Now what about the opposite? What about for hyperthyroidism?

Courtney: Yeah, so we got a couple of go-to options here. Methimazole is preferred except in the first trimester of pregnancy. That’s when we use PTU. And we have a really good memory trick there. So pregnancy, PTU comes first. Pair those Ps.

Anna: Exactly. Again, we love our memory tricks and we throw so many of those in our course. All right, let’s wrap up with mental health. What are first-line treatments for generalized anxiety disorder?

Courtney: So that’s going to be cognitive behavioral therapy and if pharmacologic treatment is warranted, that’s going to be our serotonergic agents like SSRIs or SNRIs. 

Anna: You are on fire today. Like I said, Courtney is absolutely one of our content gurus. And we’re going to wrap up today’s little quiz session, but I hope you all enjoyed this rapid review style episode. 

Always let us know if you want more of this style or if there’s any other topics you want us to cover. The best way is really to message us on our Instagram page. That’s going to be @smnpreviewsofficial. And we also love to put little free content tips and exam pearls on Instagram as well. 

And remember, this was quick hit high yield review for your exam prep. There’s so much more depth to pharmacology to explore in clinical practice and for your exam. Right, we’re going to talk about side effect profiles in our courses, alternative therapies, boxed warnings. And if you’re not quite there content wise, no big deal. It’s great that you know that now and this is a perfect place to start.

Courtney: Absolutely. And if you want to dive deeper, definitely check out our SMNP reviews courses. We’ve got comprehensive videos that walk through all of these topics and more in detail. And we go in depth even more in case scenarios, practical applications in our live study group.

Anna: Yeah, and if you want a customized session like this, don’t forget about those one-on-one readiness sessions that we talked about at the beginning.

Thank you for listening. You are going to go rock your board exam if you are testing soon, like you have absolutely got this.

Courtney: Yes. See you next time. Anna and I will be together again in two weeks talking about navigating a difficult case with difficult diagnoses.

Anna: Thanks for listening to another episode of the Real Deal Nurse Practitioner Club. If you want more information  about the different types of support that we offer to students and new nurse practitioners, you can visit npreviews, with an S, dot com. We’ll see you next week.