NSG 6005 Adv Pharm FINAL EXAM TEST BANK QUESTIONS AND ANSWERS - $16.49   Add to cart

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Chapter 1. The Role of the Nurse Practitioner NSG 6005 Adv Pharm FINAL EXAM TEST BANK QUESTIONS AND ANSWERS 1. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy 2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: 1. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program & in their APRN program. 2. Nurses care for the patient from a holistic approach & include the patient in decision making regarding their care. 3. APRNs are less likely to prescribe narcotics & other controlled substances. 4. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. 3. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. H&ing out drug samples to poor patients 4. Prescribing all generic medications to cut costs 4. Criteria for choosing an effective drug for a disorder include: 1. Asking the patient what drug they think would work best for them 2. Consulting nationally recognized guidelines for disease management 3. Prescribing medications that are available as samples before writing a prescription 4. Following U.S. Drug Enforcement Administration guidelines for prescribing 5. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs & improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health-care reform 4. The ability to shift accountability for Medicaid to the state level Chapter 2. Review of Basic Principles of Pharmacology 1. A patient’s nutritional intake & laboratory results reflect hypoalbuminemia. This is critical to prescribing because: 1. Distribution of drugs to target tissue may be affected. 2. The solubility of the drug will not match the site of absorption. 3. There will be less free drug available to generate an effect. 4. Drugs bound to albumin are readily excreted by the kidneys. 2. Drugs that have a significant first-pass effect: 1. Must be given by the enteral (oral) route only 2. Bypass the hepatic circulation 3. Are rapidly metabolized by the liver & may have little if any desired action 4. Are converted by the liver to more active & fat-soluble forms 3. The route of excretion of a volatile drug will likely be the: 1. Kidneys 2. Lungs 3. Bile & feces 4. Skin 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: 1. Assure that the drug will reach its intended target tissue 2. Are the reason for giving loading doses 3. Increase the length of time a drug is available & active 4. Are most common in collagen tissues 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: 1. Propensity to go to the target receptor 2. Biological half-life 3. Pharmacodynamics 4. Safety & side effects 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: 1. Rapidly achieves drug levels in the therapeutic range 2. Requires four- to five-half-lives to attain 3. Is influenced by renal function 4. Is directly related to the drug circulating to the target tissues 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: 1. Minimum adverse effect level 2. Peak of action 3. Onset of action 4. Therapeutic range 8. Phenytoin requires that a trough level be drawn. Peak & trough levels are done: 1. When the drug has a wide therapeutic range 2. When the drug will be administered for a short time only 3. When there is a high correlation between the dose & saturation of receptor sites 4. To determine if a drug is in the therapeutic range 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: 1. Concentration will produce therapeutic effects 2. Concentration will produce an adverse response 3. Time between doses must be shortened 4. Duration of action of the drug is too long 10. Drugs that are receptor agonists may demonstrate what property? 1. Irreversible binding to the drug receptor site 2. Upregulation with chronic use 3. Desensitization or downregulation with continuous use 4. Inverse relationship between drug concentration & drug action 11. Drugs that are receptor antagonists, such as beta blockers, may cause: 1. Downregulation of the drug receptor 2. An exaggerated response if abruptly discontinued 3. Partial blockade of the effects of agonist drugs 4. An exaggerated response to competitive drug agonists 12. Factors that affect gastric drug absorption include: 1. Liver enzyme activity 2. Protein-binding properties of the drug molecule 3. Lipid solubility of the drug 4. Ability to chew & swallow 13. Drugs administered via IV: 1. Need to be lipid soluble in order to be easily absorbed 2. Begin distribution into the body immediately 3. Are easily absorbed if they are nonionized 4. May use pinocytosis to be absorbed 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: 1. The sum of the effects of each drug individually 2. Greater than the sum of the effects of each drug individually 3. Less than the effect of each drug individually 4. Not predictable, as it varies with each individual 15. Which of the following statements about bioavailability is true? 1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2. All brands of a drug have the same bioavailability. 3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4. Combining an active drug with an inert substance does not affect bioavailability. 16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1. Water soluble & ionized drugs cross these barriers rapidly. 2. The blood-brain barrier slows the entry of many drugs into & from brain cells. 3. The fetal-placental barrier protects the fetus from drugs taken by the mother. 4. Lipid-soluble drugs do not pass these barriers & are safe for pregnant women. 17. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: 1. Inactivate prodrugs before they can be activated by target tissues 2. Change the drugs so they can cross plasma membranes 3. Change drug molecules to a form that an excretory organ can excrete 4. Make these drugs more ionized & polar to facilitate excretion 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: 1. Reduced circulation & perfusion of the kidney 2. Chronic renal disease 3. Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. When the amount of drug in the body remains constant 3. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above 21. Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. Additive 22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: 1. Reducing the dosage of one of the drugs 2. Scheduling their administration at different times 3. Prescribing a third drug to counteract the adverse reaction of the combination 4. Reducing the dosage of both drugs 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? 1. Protein malnutrition 2. Iron-deficiency anemia 3. Both 1 & 2 4. Neither 1 nor 2 24. The time required for the amount of drug in the body to decrease by 50% is called: 1. Steady state 2. Half-life 3. Phase II metabolism 4. Reduced bioavailability time 25. An agonist activates a receptor & stimulates a response. When given frequently over time, the body may: 1. Upregulate the total number of receptors 2. Block the receptor with a partial agonist 3. Alter the drug’s metabolism 4. Downregulate the numbers of that specific receptor 26. Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological & psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug 27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1. “Avoid any other oral medicines while taking this drug.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.” 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1. Disintegration 2. Toxicity 3. Malabsorption 4. Deterioration 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose 30. Which of the following variables is a factor in drug absorption? 1. The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2. A rich blood supply to the area of absorption leads to better absorption. 3. The less soluble the drug, the more easily it is absorbed. 4. Ionized drugs are easily absorbed across the cell membrane. 31. An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 & 2 4. Neither 1 nor 2 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration 34. Upregulation or hypersensitization may lead to: 1. Increased response to a drug 2. Decreased response to a drug 3. An exaggerated response if the drug is withdrawn 4. Refractoriness or complete lack of response Chapter 3. Rational Drug Selection 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because: 1. Drugs given in liquid form are less irritating to the stomach. 2. A 6-year-old child may have problems swallowing a pill. 3. Liquid forms of medication eliminate the concern for first-pass effect. 4. Liquid ibuprofen does not have to be dosed as often as the tablet form. 2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it: 1. Has serious side effects & it is not being used for a life-threatening condition 2. Will be taken twice daily & will be taken at home 3. Is expensive, but covered by health insurance 4. None of these are important in choosing a drug 3. A client asks the NP about the differences in drug effects between men & women. What is known about the differences between the pharmacokinetics of men & women? 1. Body temperature varies between men & women. 2. Muscle mass is greater in women. 3. Percentage of fat differs between genders. 4. Proven subjective factors exist between the genders. 4. The first step in the prescribing process according to the World Health Organization is: 1. Choosing the treatment 2. Educating the patient about the medication 3. Diagnosing the patient’s problem 4. Starting the treatment 5. Treatment goals in prescribing should: 1. Always be curative 2. Be patient-centered 3. Be convenient for the provider 4. Focus on the cost of therapy 6. The therapeutic goals when prescribing include(s): 1. Curative 2. Palliative 3. Preventive 4. All of the above 7. When determining drug treatment the NP prescriber should: 1. Always use evidence-based guidelines 2. Individualize the drug choice for the specific patient 3. Rely on his or her experience when prescribing for complex patients 4. Use the newest drug on the market for the condition being treated 8. Patient education regarding prescribed medication includes: 1. Instructions written at the high school reading level 2. Discussion of expected adverse drug reactions 3. How to store leftover medication such as antibiotics 4. Verbal instructions always in English 9. Passive monitoring of drug effectiveness includes: 1. Therapeutic drug levels 2. Adding or subtracting medications from the treatment regimen 3. Ongoing provider visits 4. Instructing the patient to report if the drug is not effective 10. Pharmacokinetic factors that affect prescribing include: 1. Therapeutic index 2. Minimum effective concentration 3. Bioavailability 4. Ease of titration 11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine: 1. Conflicts of interest & financial relationships should be disclosed by those providing education. 2. Providers should ban all pharmaceutical representatives from their office setting. 3. Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication. 4. Providers should only accept low-value gifts, such as pens & pads of paper, from the pharmaceutical representative. 12. Under new U.S. Food & Drug Administration labeling, Pregnancy Categories will be: 1. Strengthened with a new coding such as C or C- to discern when a drug is more or less toxic to the fetus 2. Changed to incorporate a pregnancy risk summary & clinical considerations on the drug label 3. Eliminated, & replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns 4. Clarified to include information such as safe dosages in each trimester of pregnancy Chapter 4. Legal & Professional Issues in Prescribing 1. The U.S. Food & Drug Administration regulates: 1. Prescribing of drugs by MDs & NPs 2. The official labeling for all prescription & over-the-counter drugs 3. Off-label recommendations for prescribing 4. Pharmaceutical educational offerings 2. The U.S. Food & Drug Administration approval is required for: 1. Medical devices, including artificial joints 2. Over-the-counter vitamins 3. Herbal products, such as St John’s wort 4. Dietary supplements, such as Ensure 3. An Investigational New Drug is filed with the U.S. Food & Drug Administration: 1. When the manufacturer has completed phase III trials 2. When a new drug is discovered 3. Prior to animal testing of any new drug entity 4. Prior to human testing of any new drug entity 4. Phase IV clinical trials in the United States are also known as: 1. Human bioavailability trials 2. Postmarketing research 3. Human safety & efficacy studies 4. The last stage of animal trials before the human trials begin 5. Off-label prescribing is: 1. Regulated by the U.S. Food & Drug Administration 2. Illegal by NPs in all states (provinces) 3. Legal if there is scientific evidence for the use 4. Regulated by the Drug Enforcement Administration 6. The U.S. Drug Enforcement Administration: 1. Registers manufacturers & prescribers of controlled substances 2. Regulates NP prescribing at the state level 3. Sanctions providers who prescribe drugs off-label 4. Provides prescribers with a number they can use for insurance billing 7. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: 1. Are known teratogens during pregnancy 2. May not be refilled; a new prescription must be written 3. Have a low abuse potential 4. May be dispensed without a prescription unless regulated by the state 8. Precautions that should be taken when prescribing controlled substances include: 1. Faxing the prescription for a Schedule II drug directly to the pharmacy 2. Using tamper-proof paper for all prescriptions written for controlled drugs 3. Keeping any pre-signed prescription pads in a locked drawer in the clinic 4. Using only numbers to indicate the amount of drug to be prescribed 9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include: 1. Use of chemical dependency screening tools 2. Firm limit-setting regarding prescribing controlled substances 3. Practicing “just say no” to deal with patients who are pushing the provider to prescribe controlled substances 4. All of the above 10. Behaviors predictive of addiction to controlled substances include: 1. Stealing or borrowing another patient’s drugs 2. Requiring increasing doses of opiates for pain associated with malignancy 3. Receiving refills of a Schedule II prescription on a regular basis 4. Requesting that only their own primary care provider prescribe for them 11. Medication agreements or “Pain Medication Contracts” are recommended to be used: 1. Universally for all prescribing for chronic pain 2. For patients who have repeated requests for pain medication 3. When you suspect a patient is exhibiting drug-seeking behavior 4. For patients with pain associated with malignancy 12. A prescription needs to be written for: 1. Legend drugs 2. Most controlled drugs 3. Medical devices 4. All of the above Chapter 6. Factors That Foster Positive Outcomes 1. A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment? 1. Financial status 2. Mobility 3. Social support 4. Sexual practices 2. Elena Vasquez’s primary language is Spanish, & she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? 1. Use correct medical terminology because Spanish has a Latin base. 2. Use a family member who speaks more English to act as an interpreter. 3. Use a professional interpreter or a reliable staff member who can act as an interpreter. 4. Use careful, detailed explanations. 3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug? 1. St& facing him & speak slowly & clearly. 2. Speak in low tones or find a provider who has a lower voice. 3. Write down the instructions as well as speaking them. 4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. 4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen? 1. Complexity of the drug regimen 2. Patient perception of the potential adverse effects of the drugs 3. Both 1 & 2 4. Neither 1 nor 2 5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier? 1. Increasing copayments for care 2. Unrestricted formularies for drugs, including brand names 3. Increasing the number of people who have access to care 4. Treating a wider range of disorders 6. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent? 1. Ralph states that he always takes the drug “when I feel my pressure is going up.” 2. Ralph contacts his NP to discuss the need to increase the dosage. 3. Ralph consistently keeps his follow-up appointments to check his blood pressure. 4. All of the above show that he is adherent to the drug regimen. 7. Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that: 1. Has a short half-life so that missing one dose has limited effect 2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down 3. Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea & dizziness 4. Must be taken no more than twice a day 8. Factors in chronic conditions that contribute to nonadherence include: 1. The complexity of the treatment regimen 2. The length of time over which it must be taken 3. Breaks in the usual daily routine, such as vacations & weekends 4. All of the above 9. While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when: 1. The provider spent a lot of time discussing the drugs with them 2. Their concerns & specific area of knowledge deficit were addressed 3. They were given written material, such as pamphlets, about the drugs 4. The provider used appropriate medical & pharmacological terms 10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% & 60%. To improve adherence in this population, prescribe drugs: 1. With a longer half-life so that missed doses produce a longer taper on the drug curve 2. In oral formulations that are more easily taken 3. That do not require frequent monitoring 4. Combined with patient education about the need to adhere even when symptoms are absent 11. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence? 1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing. 2. Match the clinic appointment to the next time the drug is to be refilled. 3. Write prescriptions for new drugs with shorter times between refills. 4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. 12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include: 1. Older adults & those on fixed incomes 2. Patients with chronic illnesses 3. Patients with copayments for drugs on their insurance 4. Patients on public assistance 13. Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who: 1. Are well-educated & affluent 2. Have chronic conditions 3. Self-monitor drug effects on their symptoms 4. None of the above guarantee adherence 14. Monitoring adherence can take several forms, including: 1. Patient reports from data in a drug diary 2. Pill counts 3. Laboratory reports & other diagnostic markers 4. All of the above 15. Factors that explain & predict medication adherence include: 1. Social 2. Financial 3. Health system 4. All of the above Chapter 7. Cultural & Ethnic Influences in Pharmacotherapeutics 1. Cultural factors that must be taken into account when prescribing include(s): 1. Who the decision maker is in the family regarding health-care decisions 2. The patient’s view of health & illness 3. Attitudes regarding the use of drugs to treat illness 4. All of the above 2. Ethnic differences have been found in drug: 1. Absorption 2. Hepatic metabolism 3. Filtration at the glomerulus 4. Passive tubular reabsorption 3. The National Standards of Culturally & Linguistically Appropriate Services are required to be implemented in all: 1. Hospitals 2. Clinics that serve the poor 3. Organizations that receive federal funds 4. Clinics that serve ethnic minorities 4. According to the National Standards of Culturally & Linguistically Appropriate Services, an interpreter for health care: 1. May be a bilingual family member 2. May be a bilingual nurse or other health-care provider 3. Must be a professionally trained medical interpreter 4. Must be an employee of the organization 5. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: 1. The belief among African Americans that prayer is more powerful than drugs 2. Poor compliance on the part of the African American patient 3. The genetic predisposition for illness found among African Americans 4. Discrimination, cultural barriers, & lack of access to health care 6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: 1. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs 2. Largely unknown due to lack of studies of this population 3. Rapid metabolism of alcohol, leading to increased tolerance 4. Decreased elimination of opioids, leading to increased risk for addiction 7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups. 1. True 2. False 8. Alterations in drug metabolism among Asians may lead to: 1. Slower metabolism of antidepressants, requiring lower doses 2. Faster metabolism of neuroleptics, requiring higher doses 3. Altered metabolism of omeprazole, requiring higher doses 4. Slower metabolism of alcohol, requiring higher doses 9. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: 1. Require acetylization in order to metabolize drugs 2. Are unable to tolerate higher doses of some drugs that require acetylization 3. May have a toxic reaction to drugs that require acetylization 4. Require higher doses of drugs metabolized by acetylization to achieve efficacy 10. Hispanic native healers (cur&eras): 1. Are not heavily utilized by Hispanics who immigrate to the United States 2. Use herbs & teas in their treatment of illness 3. Provide unsafe advice to Hispanics & should not be trusted 4. Need to be licensed in their home country in order to practice in the United States Chapter 8. An Introduction to Pharmacogenomics 1. 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 & one mutant allele 3. Extensive metabolizers, with two normally functioning alleles 4. All of the above 2. 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 3. Rifampin is a nonspecific CYP450 inducer that may: 1. Lead to toxic levels of rifampin & 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 4. 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 P-glycoprotein for absorption & elimination 4. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption & elimination 5. 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 6. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. 1. True 2. False 7. Pharmacogenetic testing is required by the U.S. Food & Drug Administration prior to prescribing: 1. Erythromycin 2. Digoxin 3. Cetuximab 4. Rifampin 8. Carbamazepine has a Black Box Warning recommending testing for the HLA-B*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 9. 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 10. 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 11. 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 12. 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 Chapter 10. Herbal Therapy & Nutritional Supplements 1. A good history of herb & 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 2. A potential harmful effect on patients who take some herbal medication is: 1. Constipation 2. Lead poisoning 3. Diarrhea 4. Life-threatening rash 3. 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 & kidney damage 3. Cinnamic aldehyde, which is toxic to the kidney 4. Cinnamate eugenol, which is toxic to the liver 4. Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing & 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 5. 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 6. 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 7. Herbs & supplements are regulated by the U.S. Food & Drug Administration. 1. True 2. False 8. 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 9. Valerian tea causes relaxation & can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to: 1. Cardiac disturbances 2. Central nervous system depression 3. Respiratory depression 4. Skin rashes 10. The standard dosage of St John’s wort for the treatment of mild depression is: 1. 300 mg daily 2. 100 mg three times a day 3. 300 mg three times a day 4. 600 mg three times a day 11. Patients need to be instructed regarding the drug interactions with St John’s wort, including: 1. MAO inhibitors 2. Serotonin reuptake inhibitors 3. Over-the-counter cough & cold medications 4. All of the above 12. Ginseng, which is taken to assist with memory, may potentiate: 1. Aricept 2. Insulin 3. Digoxin 4. Propranolol 13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: 1. Antihypertensives, diuretics, & digoxin 2. Antidiarrheals, antihistamines, & omeprazole 3. Penicillin antibiotic class & benzodiazepines 4. None of the above 14. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: 1. Respiratory depression 2. Cardiac disturbance 3. Salicylates poisoning 4. Life-threatening rashes 15. The role of the NP in the use of herbal medication is to: 1. Maintain competence in the prescribing of common herbal remedies 2. Recommend common over-the-counter herbs to patients 3. Educate patients & guide them to appropriate sources of care 4. Encourage patients to not use herbal therapy due to the documented dangers Chapter 11. Information Technology & Pharmacotherapeutics 1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: 1. Search for information using the most common search engines 2. Serve as content experts in developing, implementing, & evaluating information systems 3. Write programs to assure the integrity of health information 4. Use information technology to prescribe drugs 2. You are going to prescribe a drug & the electronic health record (EHR) alerts you that there is a potential drug–drug interaction. The alert is generated by: 1. The Food & Drug Administration MedWatch system 2. TOXNET, the National Institutes of Health alert system 3. The EHR clinical decision support system 4. Lexicomp, a commercial medication alert system 3. Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? 1. Reduces time that prescribing drugs takes 2. Eliminates the need to chart drugs prescribed 3. Decreases prescribing & transcription errors 4. Helps keep the number of drugs prescribed to a minimum 4. A number of barriers & concerns exist before the goals of a safe & efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption & use of IT in prescribing drugs? 1. Cost of initial setup 2. Access to highly skilled experts 3. Compatibility between systems 4. Patient confidentiality risks 5. EHRs: 1. Are being discouraged by the Centers for Medicare & Medicaid Services due to cost issues 2. Allow for all patient data to be centralized in one location for access by multiple providers 3. Use macros & templates to individualize care 4. Use standardized software to facilitate interoperability between systems 6. Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include: 1. Designing software so that only those who need the information can gain access 2. Requiring providers to log off at the end of the clinical day 3. Keeping a file of the login & password information for each provider in a secure place 4. Having patients sign informed consent documents to have their data on an EHR 7. Decision support systems often provide medication alerts that tell the prescriber: 1. Patient history data with a summary of their diagnoses 2. The usual dosage for the drug being prescribed 3. The patient’s latest laboratory values, such as potassium levels 4. Potential drug-to-drug interactions with other medications the patient is taking 8. Prescribers have been shown to override a medication alert about a patient’s allergies when: 1. The history showed that the patient had tolerated the medication in the past 2. The benefit outweighed the risk 3. The medication was therapeutically appropriate & needed 4. All of the above 9. The use of information technology for quality improvement in pharmacotherapeutics includes: 1. Incorporating the use of “apps” into all patient encounters 2. Tracking data trends within the practice via the electronic health record database 3. Informing patients that they have access to their medication list via the Internet 4. Using macros for individualizing patient care management 10. The advantage of using information technology for patient education includes: 1. The ability to track the number of times you have given the patient the same instructions regarding their medication 2. Standardized & individualized patient education that is simultaneously recorded into the patient record 3. Easy access to private patient information specific to populations with a similar diagnosis 4. The ability to download & interpret patient information in multiple languages, easily & accurately 11. One barrier to use of the Internet for both prescribing & for patient teaching is: 1. Lack of free public access to the Internet 2. Age, with older adults rarely understanding how to use a computer 3. Web pages & hyperlinks may change, be deleted, or be replaced 4. Few Web sites with information about drugs are free 12. Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to: 1. Prioritize what is needed information & avoid spending time reading “interesting” information not central to the problem at h& 2. Integrate professional & personal searching so that the same browser does not need to be accessed repeatedly 3. Check e-mail frequently so that patient questions can be addressed promptly 4. Check for viruses, spyware, & malware 13. Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review: 1. The patient’s current diagnosis & history 2. Drugs the patient is currently taking 3. Any recent previous encounter for the same problem as this visit & what was done 4. All of the above 14. Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true? 1. Patients feel the provider does not care about them if they are not seen in a face-to-face encounter. 2. Data collected from patients between encounters via IT is less accurate & complete. 3. Collecting data between encounters via IT may mean a more efficient face-to-face encounter. 4. Between encounters is a good time to collect screening data. 15. Discharge summaries using information technology have several advantages. They can: 1. Replace the need for oral instruction because the patient has printed material to read at home 2. Be filed with the patient’s chart to document patient teaching 3. Both 1 & 2 4. Neither 1 nor 2 16. Information technology can also be used for patient teaching during the encounter & after it. The provider can help patients & their families become savvy consumers of health-care information by: 1. Warning them about the questionable quality of health information online 2. Identifying easily used “apps” that patients can use to manage their medications 3. Teaching them how to identify high-quality Web sites & “red flags” signaling inaccurate content 4. All of the above 17. Incorporating information technology (IT) into a patient encounter takes skill & tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by: 1. Turning the screen around so the patient can see material being recorded 2. Not placing the computer screen between the provider & the patient 3. Both 1 & 2 4. Neither 1 nor 2 Chapter 12. Pharmacoeconomics 1. Pharmacoeconomics is: 1. The study of the part of the U.S. economy devoted to drug use 2. The study of the impact of prescription drug costs on the overall economy 3. The analysis of the costs & consequences of any health-care-related treatment or service 4. The analysis of the clinical efficacy of the drug 2. The direct costs of drug therapy include: 1. The actual cost of acquiring the medication 2. The loss of income due to illness 3. Pain & suffering due to inadequate drug therapy 4. The cost of a funeral associated with premature death 3. Indirect costs associated with drug therapy include: 1. The cost of diagnostic tests to monitor therapeutic levels 2. Health-care provider time to prescribe & educate the patient 3. Child-care expenses incurred while receiving therapy 4. Loss of wages while undergoing drug therapy 4. The intangible costs of drug therapy include: 1. Loss of wages while undergoing therapy 2. Inconvenience, pain, & suffering incurred with therapy 3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels 4. Cost of prescription drug coverage, such as Medicare Part D 5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy & compares the costs of each it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 6. Cost-effectiveness analysis compares two or more treatments or programs that are: 1. Not necessarily therapeutically equivalent 2. Considered equal in efficacy 3. Compared with the dollar value of the benefit received 4. Expressed in terms of patient preference or quality-adjusted life years 7. When the costs of a specific treatment or intervention are calculated & then compared with the dollar value of the benefit received it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 8. Mary has a two-tiered prescription benefit plan, which means: 1. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not. 2. She is eligible for the new Medicare Part D “donut hole” reduction of costs program. 3. She pays a higher copay for brand-name drugs than for generic drugs. 4. She must always choose to be treated with generic drugs first. 9. Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists: 1. Increases the complexity of the pharmacoeconomics of prescribing for the individual patient 2. Increases compliance by reducing the financial burden of drug costs to the patient 3. Is not sound prescribing practice due to the inferiority of the generic products 4. Will increase the overall cost of drugs to the system due to the ease of overprescribing less-expensive drugs 10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: 1. Order cognitive testing to determine the source of his confusion. 2. Sit down with him & explain the whole Medicare Part D process. 3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him. 4. Request his son come to the next appointment so you can explain the benefit to him. 11. The “donut hole” in Medicare Part D: 1. Will be totally eliminated with the federal health-care reform enacted in 2010 2. Refers to the period of time when annual individual drug costs are between $250 & $2,250 per year & drug costs are covered 75% 3. Refers to the period between when the annual individual drug costs are $2,970 & $4,750 & the patient pays 52.5% of the costs of brand name drugs (2013) 4. Has no effect on whether patients continue to fill their prescriptions during the coverage gap 12. Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they: 1. Ask for extra refills of medication to get them through the months of no coverage 2. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin 3. Fill their critical medications, but hold off on filling less-critical medications 4. Demonstrate no change in their prescription filling pattern Chapter 13. Over-the-Counter Medications 1. Michael asks you about why some drugs are over-the-counter & some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: 1. Be safe & labeled for appropriate use 2. Have a low potential for abuse or misuse 3. Be taken for a condition the patient can reliably self-diagnose 4. All of the above 2. In the United States, over-the-counter drugs are regulated by: 1. No one. There is no oversight for over-the-counter medications. 2. The U.S. Food & Drug Administration Center for Drug Evaluation & Research 3. The U.S. Drug Enforcement Administration 4. MedWatch 3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: 1. Get a new patent for the over-the-counter form of the drug 2. Lower the costs because most prescription benefit plans do not cover generics 3. Market the drug to a whole new population, as they are able to market to patients instead of just providers 4. Continue to make large profits from their blockbuster brand-name drug 4. New over-the-counter drug ingredients must undergo the U.S. Food & Drug Administration New Drug Application process, just as prescription drugs do. 1. True 2. False 5. The ailment that generates the greatest over-the-counter annual drug sales is: 1. Constipation 2. Cough & colds 3. Heartburn 4. Acute & chronic pain 6. Common over-the-counter pain relievers such as acetaminophen or ibuprofen: 1. Are always safer for the patient than prescription pain medication 2. Are harmful if taken in higher than recommended amounts 3. Have minimal interaction with prescription medications 4. Should never be given to children unless recommended by their provider 7. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: 1. His appropriately only telling you about his regularly prescribed medications 2. His hiding information regarding his inappropriate use of aspirin from you 3. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history 4. A common misuse of over-the-counter aspirin 8. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: 1. Requires all providers to screen their patients for methamphetamine use 2. Restricts the prescribing of amphetamines to U.S. citizens 3. Requires a prescription be written for all methamphetamine precursors in all states 4. Restricts the sales of drugs that contain methamphetamine precursors, including a daily & 30-day limit on sales 9. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: 1. Not to take their regularly prescribed medications while on these antibiotics 2. Regarding the need for lots of acidic foods & juices, such as orange juice, to enhance absorption 3. Not to take antacids while on these medications, as the antacid decreases absorption 4. That there are no drug interactions with these antibiotics Chapter 14. Drugs Affecting the Autonomic Nervous System 1. Charlie is a 65-year-old male who has been diagnosed with hypertension & benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: 1. Increases peripheral vasoconstriction 2. Decreases detrusor muscle contractility 3. Lowers supine blood pressure more than st&ing pressure 4. Relaxes smooth muscle in the bladder neck 2. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT: 1. Take the dose at bedtime 2. Sit up slowly & dangle their feet before st&ing 3. Monitor their blood pressure & skip a dose if the pressure is less than 120/80 4. Weigh daily & report weight gain of greater than 2 pounds in one day 3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: 1. Not miss a dose or stop taking the drug because of potential rebound hypertension 2. Increase fiber in the diet to treat any diarrhea that may occur 3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention 4. Avoid sitting for long periods, as this can lead to deep vein thrombosis 4. Clonidine has several off-label uses, including: 1. Alcohol & nicotine withdrawal 2. Post-herpetic neuralgia 3. Both 1 & 2 4. Neither 1 nor 2 5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: 1. Increasing heart rate to improve cardiac output 2. Reducing vascular smooth muscle tone 3. Increasing aldosterone-mediated volume activity 4. Reducing aqueous humor production 6. Which of the following adverse effects are less likely in a beta1-selective blocker? 1. Dysrhythmias 2. Impaired insulin release 3. Reflex orthostatic changes 4. Decreased triglycerides & cholesterol 7. Richard is 70 years old & has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work & find a CrCl of 25 ml/min. What action should you take related to his nadolol? 1. Extend the dosage interval. 2. Decrease the dose by 75%. 3. Take no action because this value is expected in the older adult. 4. Schedule a serum creatinine level to validate the CrCl value. 8. Beta blockers are the drugs of choice for exertional angina because they: 1. Improve myocardial oxygen supply by vasodilating the coronary arteries 2. Decrease myocardial oxygen dem& by decreasing heart rate & vascular resistance 3. Both 1 & 2 4. Neither 1 nor 2 9. Adherence to beta blocker therapy may be affected by their: 1. Short half-lives requiring twice daily dosing 2. Tendency to elevate lipid levels 3. Effects on the male genitalia, which may produce impotence 4. None of the above START PRINTING p.17. 10. Beta blockers have favorable effects on survival & disease progression in heart failure. Treatment should be initiated when the: 1. Symptoms are severe 2. Patient has not responded to other therapies 3. Patient has concurrent hypertension 4. Left ventricular dysfunction is diagnosed 11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: 1. Angina 2. Coronary artery disease 3. Both 1 & 2 4. Neither 1 nor 2 12. To prevent life-threatening events from rapid withdrawal of a beta blocker: 1. The dosage interval should be increased by 1 hour each day. 2. An alpha blocker should be added to the treatment regimen before withdrawal. 3. The dosage should be tapered over a period of weeks. 4. The dosage should be decreased by one-half every 4 days. 13. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia & block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs & so can be used to warn diabetics of possible decreased blood glucose? 1. Dizziness 2. Increased heart rate 3. Nervousness & shakiness 4. Diaphoresis 14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: 1. Vasodilate the peripheral vasculature 2. Decrease cardiac output 3. Increase renal vascular resistance 4. Reduce atherosclerosis secondary to elevated serum lipoproteins 15. Carvedilol is heavily metabolized by CYP2D6 & 2C9, resulting in drug interactions with which of the following drug classes? 1. Histamine 2 blockers 2. Quinolones 3. Serotonin re-uptake inhibitors 4. All of the above 16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? 1. White 2. Asian 3. African American 4. Native American 17. Bethanechol: 1. Increases detrusor muscle tone to empty the bladder 2. Decreases gastric acid secretion to treat peptic ulcer disease 3. Stimulates voluntary muscle tone to improve strength 4. Reduces bronchial airway constriction to treat asthma 18. Clinical dosing of Bethanechol: 1. Begins at the highest effective dose to obtain a rapid response 2. Starts at 5 mg to 10 mg PO & is repeated every hour until a satisfactory clinical response is achieved 3. Requires dosing only once daily 4. Is the same for both the oral & parenteral route 19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects? 1. Levothyroxine 2. Prilosec 3. Dulcolax 4. Diphenhydramine 20. Anticholinesterase inhibitors are used to treat: 1. Peptic ulcer disease 2. Myasthenia gravis 3. Both 1 & 2 4. Neither 1 nor 2 21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic? 1. Donepezil 2. Memantine 3. Rivastigmine 4. Galantamine 22. Taking which drug with food maximizes it bioavailability? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Memantine 23. Which of the following drugs should be used only when clearly needed in pregnant & breastfeeding women? 1. Memantine 2. Pyridostigmine 3. Galantamine 4. Rivastigmine 24. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors & serious toxic effects. Adverse reactions that require immediate action include: 1. Dizziness & headache 2. Nausea 3. Decreased salivation 4. Fasciculations of voluntary muscles 25. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? 1. Tacrine 2. Donepezil 3. Memantine 4. Pyridostigmine 26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? 1. Vasodilation & decreased heart rate 2. Increased secretion of gastric acid & motility of the GI smooth muscle 3. Release of dopamine at the pleasure center 4. Stimulation of the locus coeruleus 27. Nicotine gum products are: 1. Chewed to release the nicotine & then swallowed for a systemic effect 2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release 3. Bound to exchange resins so the nicotine is only released during chewing 4. Approximately the same in nicotine content as smoking two cigarettes 28. Nicotine replacement therapy (NRT): 1. Is widely distributed in the body only when the gum products are used 2. Does not cross the placenta & so is safe for pregnant women 3. Delays healing of esophagitis & peptic ulcers 4. Has no drug interactions when a transdermal patch is used 29. Success rates for smoking cessation using NRT: 1. Are about the same regardless of the method chosen 2. Vary from 40% to 50% at 12 months 3. Both 1 & 2 4. Neither 1 nor 2 30. Cholinergic blockers are used to: 1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines 2. Control tremors & relax smooth muscle in Parkinson’s disease 3. Inhibit the muscarinic action of ACh on bladder muscle 4. All of the above 31. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? 1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. 2. Additive antimuscarinic effects may occur with antihistamines. 3. Cholinergic blockers may decrease the sedative effects of hypnotics. 4. Cholinergic blockers are contraindicated with antipsychotics. 32. Scopolamine can be used to prevent the nausea & vomiting associated with motion sickness. The patient is taught to: 1. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired. 2. Swallow the tablet 1 hour before traveling where motion sickness is possible. 3. Place the tablet under the tongue & allow it to dissolve. 4. Change the transdermal disk daily for maximal effect. 33. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when st&ing abruptly. The best option for this patient is: 1. Continue the tamsulosin because the side effect will resolve with continued treatment. 2. Discontinue the tamsulosin & start doxazosin. 3. Have him double his fluid intake & st& more slowly. 4. Prescribe meclizine as needed for the dizziness. 34. You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice? 1. Donepezil 2. Tacrine 3. Doxazosin 4. Verapamil 35. A patient presents with a complaint of dark stools & epigastric pain described as gnawing & burning. Which of the medications is the most likely cause? 1. Acetaminophen 2. Estradiol 3. Donepezil 4. Bethanechol 36. Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications? 1. Carvedilol 2. Donepezil 3. Bethanechol 4. Tacrine 37. Activation of central alpha2 receptors results in inhibition of cardioacceleration & __ centers in the brain. 1. Vasodilation 2. Vasoconstriction 3. Cardiovascular 4. Respiratory Chapter 15. Drugs Affecting the Central Nervous System 1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: 1. Understanding that obesity is a contraindication to prescribing phentermine 2. Anorexiants may cause tolerance & should only be prescribed for 6 months 3. Patients should be monitored for postural hypotension 4. Renal function should be monitored closely while on anorexiants 2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) & St John’s wort due to: 1. Additive respiratory depression risk 2. Additive effects affecting liver function 3. The risk of serotonin syndrome 4. The risk of altered cognitive functioning 3. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_ to be used for an episode of status epilepticus. 1. IV phenobarbital 2. Rectal diazepam (Diastat) 3. IV phenytoin (Dilantin) 4. Oral carbamazepine (Tegretol) 4. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: 1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment 2. For pedal edema throughout therapy 3. Heart rate at each visit & consider altering therapy if heart rate is less than 60 bpm 4. For vision changes, such as red-green blindness, at least annually 5. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you & you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: 1. Dwayne hasn’t been taking his carbamazepine because it causes insomnia. 2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. 3. Dwayne was not originally prescribed the correct amount of carbamazepine. 4. Carbamazepine is probably not the right antiseizure medication for Dwayne. 6. Carbamazepine has a Black Box Warning due to life-threatening: 1. Renal toxicity, leading to renal failure 2. Hepatotoxicity, leading to liver failure 3. Dermatologic reaction, including Steven’s Johnson & toxic epidermal necrolysis 4. Cardiac effects, including supraventricular tachycardia 7. Long-term monitoring of patients who are taking carbamazepine includes: 1. Routine troponin levels to assess for cardiac damage 2. Annual eye examinations to assess for cataract development 3. Monthly pregnancy tests for all women of childbearing age 4. Complete blood count every 3 to 4 months 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: 1. Increased seizure activity, as this drug may auto-induce seizures 2. Altered renal function, including renal failure 3. Blood dyscrasias, which are uncommon but possible 4. Central nervous system excitement, leading to insomnia 9. Sook has been prescribed gabapentin to treat neuropathic pain & is complaining of feeling depressed & having “strange” thoughts. The appropriate initial action would be: 1. Increase her dose 2. Assess for suicidal ideation 3. Discontinue the medication immediately 4. Decrease her dose to half then slowly titrate up the dose 10. Selma, who is overweight, recently started taking topiramate for seizures & at her follow-up visit you note she has lost 3 kg. The appropriate action would be: 1. Tell her to increase her caloric intake to counter the effects of the topiramate. 2. Consult with a neurologist, as this is not a common adverse effect of topiramate. 3. Decrease her dose of topiramate. 4. Reassure her that this is a normal side effect of topiramate & continue to monitor her weight. 11. Monitoring of a patient on gabapentin to treat seizures includes: 1. Routine therapeutic drug levels every 3 to 4 months 2. Assessing for dermatologic reactions, including Steven’s Johnson 3. Routine serum electrolytes, especially in hot weather 4. Recording seizure frequency, duration, & severity 12. Scott’s seizures are well controlled on topiramate & he wants to start playing baseball. Education for Scott regarding his topiramate includes: 1. He should not play sports due to the risk of increased seizures 2. He should monitor his temperature & ability to sweat in the heat while playing 3. Reminding him that he may need higher dosages of topiramate when exercising 4. Encouraging him to use sunscreen due to photosensitivity from topiramate 13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: 1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 2. To wear sunscreen due to photosensitivity from levetiracetam 3. To get an annual eye exam while on levetiracetam 4. To report weight loss if it occurs 14. Levetiracetam has known drug interactions with: 1. Combined oral contraceptives 2. Carbamazepine 3. Warfarin 4. Few, if any, drugs 15. Zainab is taking lamotrigine (Lamictal) & presents to the clinic with fever & lymphadenopathy. Initial evaluation & treatment includes: 1. Reassuring her she has a viral infection & to call if she isn’t better in 4 or 5 days 2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure 3. Rapid strep test & symptomatic care if strep test is negative 4. Observation only, with further assessment if she worsens 16. Samantha is taking lamotrigine (Lamictal) for her seizures & requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine & may cause: 1. Contraceptive failure 2. Excessive weight gain 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed 17. The tricyclic antidepressants should be prescribed cautiously in patients with: 1. Eczema 2. Asthma 3. Diabetes 4. Heart disease 18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand t

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