NR 565 Week 4 Midterm Study Guide (1)

Chapter 2. Review of Basic Principles of Pharmacology 1. Question: Apatient’snutritionalintakeandlaboratoryresultsreflecthypoalbuminemia.Thisis critical to prescribing because: 2. Question: Drugs that have a significant first-passeffect: 3. Question: Medroxy progesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir 4. Question: The route of excretion of a volatile drug will likely be the: Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir 5. Question: The NP chooses to give cephalexin every 8 hours based on knowledge of thedrug’s: 6. Question: 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 loadingdose: 7. Question: The point in time on the drug concentration curve that indicates the first sign ofa therapeutic effect isthe: 8. Question: Phenytoin requires that a trough level be drawn. Peak and trough levels are done: 9. Question: A laboratory result indicates that the peak level for a drug is above the minimumtoxic concentration. This means thatthe: 10. Question: Drugs that are receptor agonists may demonstrate what property? 11. Question: Drugs that are receptor antagonists, such as beta blockers, maycause: 12. Question: Factors that affect gastric drug absorptioninclude: 13. Question: Drugs administered via IV: 14. Question: When a medication is added to a regimen for a synergistic effect, the combined effect ofthe drugs is: 15. Question: Which of the following statements about bioavailability is true? 16. Question: Which of the following statements about the major distribution barriers (blood-brain orfetal- placental) istrue? 17. Question: 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: 18. Question: Once they have been metabolized by the liver, the metabolites maybe: 19. Question: All drugs continue to act in the body until they are changed or excreted. The ability ofthe body to excrete drugs via the renal system would be increasedby: 20. Question: Steady stateis: 21. Question: Two different pain medications are given together for pain relief. The drug—druginteraction 22. Question: Actions taken to reduce drug—drug interaction problems include all of thefollowing EXCEPT: 23. Question: Phase I oxidative-reductive processes of drug metabolism require certainnutritional elements. Which of the following would reduce or inhibit thisprocess? 24. Question: The time required for the amount of drug in the body to decrease by 50% iscalled: 25. Question: An agonist activates a receptor and stimulates a response. When given frequently overtime, the body may: 26. Question: Drug antagonism is best defined as an effect of a drugthat: 27. Question: Instructions to a client regarding self-administration of oral enteric-coated tabletsshould include which of the followingstatements? 28. Question: The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 29. Question: Which of the following substances is the most likely to be absorbed in the intestinesrather than in thestomach? 30. Question: Which of the following variables is a factor in drugabsorption? 31. Question: An advantage of prescribing a sublingual medication is that the medicationis: 32. Question: Drugs that use CYP 3A4 isoenzymes for metabolism may: 33. Question: Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reachsteady state: 34. Question: Upregulation or hypersensitization may lead to: Chapter 7. Cultural and Ethnic Influences in Pharmacotherapeutics 1. Question: Cultural factors that must be taken into account when prescribing include(s): 2. Question: Ethnic differences have been found in drug: 3. Question: The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all: 4. Question: According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care: 5. Question: According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: 6. Question: The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: 7. Question: Pharmacokinetics among Asians are universal to all the Asian ethnic groups. 8. Question: Alterations in drug metabolism among Asians may lead to: 9. Question: Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: 10. Question: Hispanic native healers (curanderas): Chapter 8. An Introduction to Pharmacogenomics 1. Question: Genetic polymorphisms account for differences in metabolism,including: 2. Question: Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leadingto: 3. Question: Rifampin is a nonspecific CYP450 inducer thatmay: 4. Question: Inhibition of P-glycoprotein by a drug such as quinidine may leadto: 5. Question: Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: 6. Question: Genetic testing for VCORC1 mutation to assess potential warfarin resistance is requiredprior to prescribing warfarin. 7. Question: Pharmacogenetic testing is required by the U.S. Food and Drug Administration priorto prescribing: 8. Question: Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allelein patients with Asian ancestry prior to starting therapy dueto: 9. Question: A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivatedby the body may lead to: 10. Question: Patients who have a poor metabolism phenotype willhave: 11. Question: Ultra-rapid metabolizers of drugs mayhave: 12. Question: A provider may consider testing for CYP2D6 variants prior to starting tamoxifen forbreast cancerto: Chapter 1. The Role of the Nurse Practitioner 1. Question: Nurse practitioner prescriptive authority is regulatedby: 2. Question: The benefits to the patient of having an Advanced Practice Registered Nurse(APRN) prescriberinclude: 3. Question: Clinical judgment in prescribingincludes: 4. Question: Criteria for choosing an effective drug for a disorderinclude: 5. Question: Nurse practitioner practice may thrive under health-care reform because of: Chapter 4. Legal and Professional Issues in Prescribing 1. Question: The U.S. Food and Drug Administration regulates: 2. Question: The U.S. Food and Drug Administration approval is required for: 3. Question: An Investigational New Drug is filed with the U.S. Food and Drug Administration: 4. Question: Phase IV clinical trials in the United States are also known as: 5. Question: Off-label prescribing is: 6. Question: The U.S. Drug Enforcement Administration: 7. Question: Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: 8. Question: Precautions that should be taken when prescribing controlled substances include: 9. Question: Strategies prescribers can use to prevent misuse of controlled prescription drugs include: 10. Question: Behaviors predictive of addiction to controlled substances include: 11. Question: Medication agreements or “Pain Medication Contracts” are recommended to be used: 12. Question: A prescription needs to be written for: Chapter 13. Over-the-Counter Medications 1. Question: Michael asks you about why some drugs are over-the-counter and some are prescription.You explain that in order for a drug to be approved for over-the-counter use the drugmust: 2. Question: In the United States, over-the-counter drugs are regulatedby: 3. Question: As drugs near the end of their patent, pharmaceutical companies may apply for the drugto change to over-the-counter status in orderto: 4. Question: New over-the-counter drug ingredients must undergo the U.S. Food and DrugAdministration New Drug Application process, just as prescription drugsdo. 5. Question: The ailment that generates the greatest over-the-counter annual drug salesis: 6. Question: Common over-the-counter pain relievers such as acetaminophen oribuprofen: 7. Question: 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 exampleof: 8. Question: The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. PatriotAct: 9. Question: When prescribing a tetracycline or quinolone antibiotic it is critical to instruct thepatient: Chapter 25. Drugs Used in Treating Inflammatory Processes 1. Question: Henry presents to clinic with a significantly swollen, painful great toe and is diagnosedwith gout. Of the following, which would be the best treatment for Henry? 2. Question: Patient education when prescribing colchicine includes: 3. Question: Larry is taking allopurinol to prevent gout. Monitoring of a patient who is takingallopurinol includes: 4. Question: Phil is starting treatment with febuxostat (Uloric). Education of patients startingfebuxostat includes: 5. Question: Sallie has been taking 10 mg per day of prednisone for the past 6 months. She shouldbe assessed for: 6. Question: Patients whose total dose of prednisone will exceed 1 gram will most likely need asecond prescriptionfor: 7. Question: Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisonediscontinued? 8. Question: Patients with rheumatoid arthritis who are on chronic low-dose prednisone will needco- treatment with which medications to prevent further adverseeffects? 9. Question: Patients who are on or who will be starting chronic corticosteroid therapy need monitoringof: 10. Question: Patients who are on chronic long-term corticosteroid therapy need education regarding: 11. Question: All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black BoxWarning regarding: 12. Question: Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodinincludes: 13. Question: When prescribing NSAIDS, a complete drug history should be conducted asNSAIDs interact with thesedrugs: 14. Question: Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain withibuprofen. What education would her parent need regardingibuprofen? 15. Question: Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment forHenry? 16. Question: The trial period to determine effective anti-inflammatory activity when starting a patienton aspirin for rheumatoid arthritisis: 17. Question: Patients prescribed aspirin therapy require education regarding the signs of aspirintoxicity. An early sign of aspirin toxicityis: 18. Question: Monitoring a patient on a high-dose aspirin levelincludes: 19. Question: Patients who are on long-term aspirin therapyshouldhave annually. Chapter 52. Pain Management: Acute and Chronic Pain 1. Question: Different areas of the brain are involved in specific aspects of pain. The reticular andlimbic systems in the brain influencethe: 2. Question: Patients need to be questioned about all pain sitesbecause: 3. Question: The chemicals that promote the spread of pain locallyinclude: 4. Question: Narcotics are exogenous opiates. They actby: 5. Question: Age is a factor in different responses to pain. Which of the following age-relatedstatements about pain is NOTtrue? 6. Question: Which of the following statements is true about acutepain? 7. Question: One of the main drug classes used to treat acute pain is NSAIDs. They are usedbecause: 8. Question: Opiates are used mainly to treat moderate to severe pain. Which of the following is NOTtrue about thesedrugs? 9. Question: If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given inwhich order of use? 10. Question: The goal of treatment of acute painis: 11. Question: Which of the following statements is true about age andpain? 12. Question: Pain assessment to determine adequacy of pain management is important for allpatients. This assessment is doneto: 13. Question: Pathological similarities and differences between acute pain and chronic paininclude: 14. Question: A treatment plan for management of chronic pain should include: 15. Question: Chronic pain is a complex problem. Some specific strategies to deal with it include: 16. Question: Chemical dependency assessment is integral to the initial assessment of chronic pain.Which of the following raises a “red flag” about potential chemicaldependency? 17. Question: The Pain Management Contract is appropriate for: Chapter 14. Drugs Affecting the Autonomic Nervous System 1. Question: Charlie is a 65-year-old male who has been diagnosed with hypertension and benignprostatic hyperplasia. Doxazosin has been chosen to treat his hypertension becauseit: 2. Question: To reduce potential adverse effects, patients taking a peripherally acting alpha1antagonist should do all of the followingEXCEPT: 3. Question: John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension.He should 4. Question: Clonidine has several off-label uses,including: 5. Question: Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: 6. Question: Which of the following adverse effects are less likely in a beta1-selectiveblocker? 7. Question: Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What actionshould you take related to hisnadolol? 8. Question: Beta blockers are the drugs of choice for exertional angina becausethey: 9. Question: Adherence to beta blocker therapy may be affected by their: 10. Question: Beta blockers have favorable effects on survival and disease progression in heartfailure. Treatment should be initiated whenthe: 11. Question: Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk forserious consequences of rapid withdrawal are thosewith: 12. Question: To prevent life-threatening events from rapid withdrawal of a beta blocker: 13. Question: Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics ofpossible decreased blood glucose? 14. Question: Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: 15. Question: Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactionswith which of the following drug classes? 16. Question: Alpha-beta blockers are especially effective to treat hypertension for which ethnicgroup? 17. Question: Bethanechol: 18. Question: Clinical dosing ofBethanechol: 19. Question: Patients who need to remain alert are taught to avoid which drug due to itsantimuscarinic effects? 20. Question: Anticholinesterase inhibitors are used totreat: 21. Question: Which of the following drugs used to treatAlzheimer’s disease is not an anticholinergic? 22. Question: Taking which drug with food maximizes it bioavailability? 23. Question: Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? 24. Question: There is a narrow margin between first appearance of adverse reaction toAChE inhibitors and serious toxic effects. Adverse reactions that require immediate actioninclude: 25. Question: Adherence is improved when a drug can be given once daily. Which of the following drugs can be given oncedaily? 26. Question: Nicotine has a variety of effects on nicotinic receptors throughout the body. Which ofthe following is NOT an effect ofnicotine? 27. Question: Nicotine gum productsare: 28. Question: Nicotine replacement therapy (NRT): 29. Question: Success rates for smoking cessation using NRT: 30. Question: Cholinergic blockers are usedto: 31. Question: Several classes of drugs have interactions with cholinergic blockers. Which of thefollowing is true about theseinteractions? 32. Question: Scopolamine can be used to prevent the nausea and vomiting associated withmotion sickness. The patient is taughtto: 33. Question: You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly.The best option for this patient is: 34. Question: 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 bestchoice? 35. Question: A patient presents with a complaint of dark stools and epigastric pain described asgnawing and burning. Which of the medications is the most likelycause? 36. Question: 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-threateningcomplications? 37. Question: Activation of central alpha2 receptors results in inhibition of cardioaccelerationand ___________ centers in the brain. Chapter 15. Drugs Affecting the Central Nervous System 1. Question: Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity.A trial of phentermine is prescribed. Prescribing precautionsinclude: 2. Question: 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) and St John’s wort dueto: 3. Question: 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 homeprescriptionfor to be used for an episode of statusepilepticus. 4. Question: Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levelsinclude: 5. Question: Carbamazepine has a Black Box Warning due tolife-threatening: 6. Question: Long-term monitoring of patients who are taking carbamazepine includes: 7. Question: Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures.She should be monitoredfor: 8. Question: Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action wouldbe: 9. Question: Selma, who is overweight, recently started taking topiramate for seizures and at herfollow- up visit you note she has lost 3 kg. The appropriate action wouldbe: 10. Question: Monitoring of a patient on gabapentin to treat seizuresincludes: 11. Question: Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramateincludes: 12. Question: Cara is taking levetiracetam (Keppra) to treat seizures. Routine education forlevetiracetam includes reminding her: 13. Question: Levetiracetam has known drug interactionswith: 14. Question: Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: 15. Question: Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescriptionfor combined oral contraceptives (COCs), which interact with lamotrigine and maycause: 16. Question: The tricyclic antidepressants should be prescribed cautiously in patients with: 17. Question: 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 the following regarding phenelzine and other monoamine oxidase inhibitors(MAOIs): 18. Question: Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for childrenis: 19. Question: Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI),for depression. Education regarding her antidepressantincludes: 20. Question: Cecilia presents with depression associated with complaints of fatigue, sleeping all thetime, and lack of motivation. An appropriate initial antidepressant for her wouldbe: 21. Question: Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acutepsychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: 22. Question: Anticholinergic agents, such as benztropine (Cogentin), may be given with aphenothiazine to: 23. Question: Patients who are prescribed olanzapine (Zyprexa) should be monitored for: A 19-year-old male was started on risperidone. Monitoring for risperidoneincludes observing for common side effects, including: 24. Question: In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood ofrapidly developing dependence is: 25. Question: A patient with anxiety and depression may respond to: 26. Question: When prescribing temazepam (Restoril) for insomnia, patient education includes: 27. Question: Patients should be instructed regarding the rapid onset of zolpidem (Ambien)because: 28. Question: One major drug used to treat bipolar disease is lithium. Because lithium has anarrow therapeutic range, it is important to recognize symptoms of toxicity, such as: 29. Question: Tom is taking lithium for bipolar disorder. He should be taught to: 30. Question: Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant.What advice would you give her? 31. Question: When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: 32. Question: Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain.The appropriate first-line medication would be: 33. Question: Kasey fractured his ankle in two places and is asking for medication for his pain.The appropriate first-line medication would be: 34. Question: Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate(Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: 35. Question: Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD)includes: 36. Question: When prescribing Adde rall(amphetamineanddextroamphetamine)to adults with ADHD the nurse practitioner will need to monitor: Chapter 29. Anxiety and Depression 1. Question: Common mistakes practitioners make in treating anxiety disordersinclude: 2. Question: An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: 3. Question: An appropriate drug to initially treat panic disorder is: 4. Question: Prior to starting antidepressants, patients should have laboratory testing to ruleout: 5. Question: David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication wouldinclude: 6. Question: Jamison has been prescribed citalopram (Celexa) to treat his depression. Educationregarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: 7. Question: An appropriate drug for the treatment of depression with anxiety wouldbe: 8. Question: An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: 9. Question: The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is: 10. Question: Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants? 11. Question: The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? 12. Question: What “onset of action” symptoms should be reviewed with patients who have beennewly prescribed a selective serotonin reuptake inhibitor? 13. Question: Which of the following should not be taken with a selective serotonin re uptake inhibitor? 14. Question: Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors(SSRIs)? 15. Question: The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the bestresponse? Chapter 35. Headaches 1. Question: Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes: 2. Question: A first-line drug for abortive therapy in simple migraine is: 3. Question: Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2years for migraines and states one dose usually works to abort her migraine. What is the best care for her? 4. Question: When prescribing ergotamine suppositories (Wigraine) to treat acute migraine,patient education would include: 5. Question: Migraines in pregnancy may be safely treated with: 6. Question: Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: 7. Question: Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: 8. Question: Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would beappropriate? 9. Question: Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraineon average of once a month. The migraines are effectively aborted with naratriptan(Amerge). When refilling Amber’s naratriptan, education would include: 10. Question: When prescribing for migraines, patient education includes: 11. Question: Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for: 12. Question: Non pharmacologic therapy for tension headaches includes: 13. Question: James has been diagnosed with cluster headaches. Appropriate acute therapy would be: 14. Question: Preventative therapy for cluster headaches includes: 15. Question: When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they: