AANP-FNP exam Class 11 pharmacology

Genetic polymorphisms account for differences in metabolism, including: 1. Poor metabolizers, who lack a working enzyme 2. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele 3. Extensive metabolizers, with two normally functioning alleles 4. All of the above - 4. All of the above Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: 1. A need to monitor drugs metabolized by 2D6 for toxicity 2. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors 3. Decreased conversion of codeine to morphine by CYP 2D6 4. The need for lowered dosages of drugs, such as beta blockers - 2. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors Rifampin is a nonspecific CYP450 inducer that may: 1. Lead to toxic levels of rifampin and must be monitored closely 2. Cause toxic levels of drugs, such as oral contraceptives, when coadministered 3. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure 4. Cause nonspecific changes in drug metabolism - 3. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure Inhibition of P-glycoprotein by a drug such as quinidine may lead to: 1. Decreased therapeutic levels of quinidine 2. Increased therapeutic levels of quinidine 3. Decreased levels of a coadministered drug, such as digoxin, that requires Pglycoprotein for absorption and elimination 4. Increased levels of a coadministered drug, such as digoxin, that requires Pglycoprotein for absorption and elimination - 4. Increased levels of a coadministered drug, such as digoxin, that requires Pglycoprotein for absorption and elimination Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: 1. Toxic levels of warfarin building up 2. Decreased response to warfarin 3. Increased risk for significant drug interactions with warfarin 4. Less risk of drug interactions with warfarin - 2. Decreased response to warfarin Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. 1. True 2. False - 2. False Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing: 1. Erythromycin 2. Digoxin 3. Cetuximab 4. Rifampin - 3. Cetuximab Carbamazepine has a Black Box Warning recommending testing for the HLAB* 1502 allele in patients with Asian ancestry prior to starting therapy due to: 1. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele 2. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele 3. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 4. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine - 3. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to: 1. Decreased effectiveness of irinotecan in the treatment of cancer 2. Increased adverse drug reactions, such as neutropenia 3. Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 4. Increased concerns for irinotecan being carcinogenic - 2. Increased adverse drug reactions, such as neutropenia Patients who have a poor metabolism phenotype will have: 1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 2. Accumulation of inactive metabolites of drugs 3. A need for increased dosages of medications 4. Increased elimination of an active drug - 1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug Ultra-rapid metabolizers of drugs may have: 1. To have dosages of drugs adjusted downward to prevent drug accumulation 2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 3. Increased elimination of active, nonmetabolized drug 4. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug - 2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: 1. Ensure the patient will not have increased adverse drug reactions to the tamoxifen 2. Identify potential drug-drug interactions that may occur with tamoxifen 3. Reduce the likelihood of therapeutic failure with tamoxifen treatment 4. Identify poor metabolizers of tamoxifen - 3. Reduce the likelihood of therapeutic failure with tamoxifen treatment The most frequent type of drug-food interaction is food: 1. Causing increased therapeutic drug levels 2. Affecting the metabolism of the drug 3. Altering the volume of distribution of drugs 4. Affecting the gastrointestinal absorption of drugs - 4. Affecting the gastrointestinal absorption of drugs Food in the gastrointestinal tract affects drug absorption by: 1. Altering the pH of the colon, which decreases absorption 2. Competing with the drug for plasma proteins 3. Altering gastric emptying time 4. Altering the pH of urine - 3. Altering gastric emptying time Food can alter the pH of the stomach, leading to: 1. Enhanced drug metabolism 2. Altered vitamin K absorption 3. Increased vitamin D absorption 4. Altered drug bioavailability - 4. Altered drug bioavailability Fasting for an extended period can: 1. Increase drug absorption due to lack of competition between food and the drug 2. Alter the pH of the gastrointestinal tract, affecting absorption 3. Cause vasoconstriction, leading to decreased drug absorption 4. Shrink the stomach, causing decreased surface area for drug absorption - 3. Cause vasoconstriction, leading to decreased drug absorption Tetracycline needs to be given on an empty stomach because it chelates with: 1. Calcium 2. Magnesium 3. Iron 4. All of the above - 4. All of the above A low-carbohydrate, high-protein diet may: 1. Increase drug-metabolizing enzymes 2. Decrease drug absorption from the GI tract 3. Alter drug binding to plasma proteins 4. Enhance drug elimination - 1. Increase drug-metabolizing enzymes Grapefruit juice contains furanocoumarins that have been found to: 1. Alter absorption of drugs through competition for binding sites 2. Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs 3. Alter vitamin K metabolism, leading to prolonged bleeding 4. Enhance absorption of calcium and vitamin D - 2. Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs Cruciferous vegetables may alter drug pharmacokinetics by: 1. Enhancing absorption of weakly acidic drugs 2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins 3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2 4. Decreasing first-pass metabolism of drugs - 3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2 Milk and other foods that alkalinize the urine may: 1. Result in basic drugs being reabsorbed in the renal tubule 2. Increase the elimination of basic drugs in the urine 3. Decrease the elimination of acidic drugs 4. Not alter drug elimination due to the minimal change in urine pH - 1. Result in basic drugs being reabsorbed in the renal tubule Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following nutrients? 1. Protein 2. Calcium 3. Iron 4. Vitamin K - 3. Iron Phenytoin decreases folic acid absorption by: 1. Altering the pH of the stomach 2. Increasing gastric emptying time 3. Inhibiting intestinal enzymes required for folic acid absorption 4. Chelation of the folic acid into inactive ingredients - 3. Inhibiting intestinal enzymes required for folic acid absorption Patients taking warfarin need to be educated about the vitamin K content of foods to avoid therapeutic failure. Foods high in vitamin K that should be limited to no more than one serving per day include: 1. Spinach 2. Milk 3. Romaine lettuce 4. Cauliflower - 1. Spinach The American Dietetic Association has recommended the use of specific nutritional supplements in the following population(s): 1. 400 IU per day of vitamin D in all infants and children 2. 1,000 IU per day of vitamin D for all pregnant women 3. 60 mg per day of iron for all adults over age 50 years 4. All of the above - 1. 400 IU per day of vitamin D in all infants and children The American Dietetic Association recommends pregnant women take a supplement including: 1. 1,000 IU daily of vitamin D 2. 2.4 mcg/day of vitamin B12 3. 600 mcg/day of folic acid 4. 8 mg/day of iron - 3. 600 mcg/day of folic acid The American Heart Association and the American Dietetic Association recommend a minimum daily fiber intake of ______ for cardiovascular health: 1. 10 mg/day 2. 15 mg/day 3. 20 mg/day 4. 25 mg/day - 4. 25 mg/day Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount? 1. Iron 2. Vitamin A 3. Vitamin B6 4. Vitamin C - 2. Vitamin A Vitamin B2 (riboflavin) may be prescribed to: 1. Decrease the incidence of beriberi 2. Reduce headaches and migraines 3. Prevent pernicious anemia 4. Treat hyperlipidemia - 2. Reduce headaches and migraines Isoniazid (INH) may induce a deficiency of which vitamin? 1. B6 2. C 3. D 4. E - 1. B6 Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent: 1. Beriberi 2. Peripheral neuropathy 3. Rickets 4. Megaloblastic anemia - 2. Peripheral neuropathy Vitamin B12 deficiency may lead to: 1. Hair loss 2. Insomnia 3. Dry scales on the scalp 4. Numbness and tingling of the hands - 4. Numbness and tingling of the hands Smokers are at risk for vitamin C deficiency. It is recommended that smokers take _______ vitamin C supplement. 1. 100 mg/day 2. 500 mg/day 3. 1,000 mg/day 4. 35 mg/day more than nonsmokers - 4. 35 mg/day more than nonsmokers There is strong evidence to support that adequate vitamin C intake prevents: 1. The common cold 2. Breast cancer 3. Scurvy 4. All of the above - 3. Scurvy Adequate vitamin D is needed for: 1. Absorption of calcium from the gastrointestinal tract 2. Regulation of serum calcium levels 3. Regulation of serum phosphate levels 4. All of the above - 4. All of the above Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of Pediatrics recommends that all newborns receive: 1. IM vitamin K (phytonadione) within 24 hours of birth 2. Oral vitamin K supplementation in the first 3 weeks of life 3. Formula containing vitamin K or breast milk 4. Oral vitamin K in the first 24 hours after birth - 1. IM vitamin K (phytonadione) within 24 hours of birth Symptoms of folate deficiency include: 1. Thinning of the hair 2. Bruising easily 3. Glossitis 4. Numbness and tingling of the hands and feet - 3. Glossitis A patient with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency? 1. Vitamin B12 2. Vitamin C 3. Folate 4. Niacine - 3. Folate According to the National Health and Nutrition Examination Survey study of dietary intake, the group at highest risk for inadequate calcium intake was: 1. The elderly (over age 60 years) 2. Teenage females 3. Teenage males 4. Preschoolers - 2. Teenage females Patients with iron deficiency will develop: 1. Hemolytic anemia 2. Megaloblastic anemia 3. Macrocytic-hypochromic anemia 4. Microcytic-hypochromic anemia - 4. Microcytic-hypochromic anemia There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well-documented: 1. Concern for developing cardiac dysrhythmias 2. Anti-inflammatory effects 3. Total cholesterol-lowering effects 4. Effects on fasting blood sugar - 2. Anti-inflammatory effects There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient? 1. Vitamin B1 (thiamine) 2. Vitamin B2 (riboflavin) 3. Calcium 4. Omega-3 fatty acids - 4. Omega-3 fatty acids There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s): 1. Asthma 2. Autism 3. Arthritis 4. All of the above - 2. Autism It is reasonable to recommend supplementation with _________ in the treatment of hyperlipidemia. 1. Omega-3 fatty acids 2. Probiotics 3. Plant sterols 4. Calcium - 3. Plant sterols Probiotics are recommended to be co-administered when ____________ are prescribed: 1. Antacids 2. Antihypertensives 3. Antidiarrheals 4. Antibiotics - 4. Antibiotics It is reasonable to add ___________ to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori. 1. Probiotics 2. Omega-3 fatty acids 3. Plant sterols 4. Fiber - 1. Probiotics A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products. 1. 10 2. 5 3. 38 4. 70 - 3. 38 A potential harmful effect on patients who take some herbal medication is: 1. Constipation 2. Lead poisoning 3. Diarrhea 4. Life-threatening rash - 2. Lead poisoning A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: 1. Coumadin, which may lead to bleeding problems 2. Coumarin, which can cause liver and kidney damage 3. Cinnamic aldehyde, which is toxic to the kidney 4. Cinnamate eugenol, which is toxic to the liver - 2. Coumarin, which can cause liver and kidney damage Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: 1. Herbs which are yang in nature 2. Herbs that are yin in nature 3. Ginger 4. Golden seal - 2. Herbs that are yin in nature According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient's illness will: 1. Get worse 2. Get better 3. Not be adequately treated 4. Need additional herbs to treat the yang - 1. Get worse In Ayurvedic medicine, treatment is based on the patient's dominant dosha, which is referred to as the person's: 1. Vata 2. Pitta 3. Kapha 4. Prakriti - 4. Prakriti Herbs and supplements are regulated by the U.S. Food and Drug Administration. 1. True 2. False - 2. False When melatonin is used to induce sleep, the recommendation is that the patient: 1. Take 10 mg 30 minutes before bed nightly 2. Take 1 to 5 mg 30 minutes before bed nightly 3. Not take melatonin more than three nights a week 4. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep - 3. Not take melatonin more than three nights a week