Advanced Pharmacology Final - Practice Quiz Questions and answers

Escitalopram may cause serious, potentially fatal reactions when used with _______________. (select all that apply) - Duloxetine, amitriptilyne, sertraline, St. John's Wort Mixing two serotonin agents can cause serotonin syndrome. The therapeutic effects of imipramine develop over _____________. - Several weeks The FDA-approved indications for fluoxetine include: (select all that apply) - Obsessive compulsive disorder, major depressive disorder, bulimia nervosa Taking food with buspirone alters absorption. - False May be taken with food to minimize gastric irritation Venlafaxine is extensively metabolized on first pass through the ___________. - Liver Signs and symptoms of lithium toxicity include: (select all that apply) - Slurred speech, drowsiness Valproate acid has FDA-approved indications for: (select all that apply) - Acute mania, simple and complex absence seizures, prevention of migraine headaches Atomoxetine selectively ____________ the presynaptic reuptake of norepinephrine resulting in a(n) ________________ attention span. - Inhibits, improved Phenelzine does not need to be discontinued several days before elective surgery that requires anesthesia. - False Bupropion can be used for smoking cessation. - True Methylphenidate is not effective for narcoleptic patients. - False Clozapine may cause: (select all that apply) - Syncope, orthostatic hypotension, cardiac arrest Causes bradycardia which could lead to syncope and cardiac arrest Administering risperidone with levodopa is contraindicated. - True It decreases the effects of levodopa The ___________ form of ziprasidone is frequently used for control of acutely agitated patients. - Intramuscular (IM) Anticonvulsants are frequently used as mood stabilizers for the treatment of mania and bipolar spectrum disorders because they: - Reduce synaptic kindling A patient was started on fluoxetine for depression 3 days ago. She now complains that it "doesn't help" and refuses to take it. Understanding the psychopharmacology, the nurse's best first action is to: - Discuss with the patient that these types of medications often take several weeks before seeing the results. Which of the following is a common side effect of both first- and second-generation antipsychotic drugs? (select all that apply) - Extrapyramidal side effects such as pseudo-parkinsonism or acute dystonia, neuroleptic malignant syndrome, excessive sedation A male patient who is taking the second-generation antipsychotic reports to the nurse that he has observed a clear fluid leaking from his right nipple for the past month. The nurse's best initial intervention is: - Inform the patient that this could be a side effect of the medication The physician discusses the appropriateness of prescribing a serotonin/norepinephrine reuptake inhibitor (SNRI) for a patient. Which of the following medications are in this category? - Venlafaxine and duloxetine A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse should counsel the patient about which of the following possible side effects, among others? - Fever, sweating, agitation, rapid heartbeat A nurse counsels a patient who has been prescribed a monoamine oxidase inhibitor (MAOI) to treat depression to avoid foods containing tyramine. Which of the following foods should the patient avoid? (select all that apply) - Yogurt, tofu, pepperoni A patient with severe kidney disease is started on lithium by a new resident. As the nurse on duty your best initial response would be to: - Contact the resident to remind him that the client has kidney disease and lithium is contraindicated Which of the following is generally true of medications used to treat anxiety disorders? - Just as with depression, the most common medications prescribed are serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). For which one of the following types of drugs is the consumption of grapefruit juice contraindicated? - Second-generation antipsychotics Psychopharmaceutical agents are prescribed for individuals with substance use disorders for all of the following reasons except: - To elevate the patient's mood in a manner comparable to the action of the misused substance A patient has been prescribed disulfiram. The nurse would most appropriately counsel the patient about which of the following? - A toxic reaction if alcohol is consumed When a patient is prescribed risperidone for schizoaffective disorder, the nurse must alert the patient to the potential for neuroleptic malignant syndrome. Which of the following would be accurate information to give the patient? - Neuroleptic malignant syndrome is potentially fatal. It usually occurs during the first 2 weeks after starting an antipsychotic drug or increasing the dose and is characterized by high fever, muscle stiffness, paranoia, sweating, and large changes in blood pressure. A client with depression is taking phenelzine. The nurse advises the client to avoid consuming which foods while taking the medication - Yogurt Methylphenidate is a CNS stimulant and is the drug of choice for individuals with attention-deficit/hyperactivity disorder (ADHD). The desired effects of methylphenidate may be noted as: - Increased attention span and concentration The risk of experiencing serotonin syndrome when selective serotonin reuptake inhibitors (SSRIs) are given with monoamine oxidase inhibitors (MAOIs) such as phenelzine. Serotonin syndrome is best characterized in which of the following? - Muscle rigidity and high fever A 19-year-old female client with depression who has been taking amitriptyline for three weeks returns to the clinic for a follow-up. The nurse anticipates the possibility of observing which of the following symptoms? - Suicidal thoughts A newly admitted client has started taking bupropion. The nurse understands which of the following side effects that would indicate an overdose of the medication? - Seizure A client taking lithium carbonate started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium serum level is 2 mEq/L. The nurse interprets this value as: - Toxic level Which of the following symptoms is a sign of mild lithium toxicity: - Course tremor and lethargy A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines that the client is experiencing? - Tardive dyskinesia A client with schizophrenia has been started on medication therapy with clozapine. A nurse assesses the results of which laboratory study to monitor for adverse effect related to this medication? - White blood cell Methylphenidate is prescribed to an 8-year-old child for the treatment of attention-deficit/hyperactivity disorder (ADHD). The nurse plans to monitor which of the following during the medication therapy? - Height and weight Can cause slow growth and reduced appetite A client who has been taking buspirone for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of... - Feelings of panic, fear, and uneasiness Your patient is taking the antipsychotic medications clozapine and divalproex sodium (Depakote), both of which can contribute to weight gain. For what should this patient be carefully monitored? - Increased blood glucose Nurse Trini knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): - Fluvoxamine and clomipramine A patient diagnosed with schizophrenia has taken thiothixene 5 mg/day for 4 years with good symptom control. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should determine if the patient's symptoms are related to: - Not taking the drug as prescribed When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for extrapyramidal side effects (EPSEs) particularly: - Akathisia Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. Benefits specific to use of nortriptyline would include: - Improved sleep pattern A patient with depression has taken a selective serotonin reuptake inhibitors (SSRIs) for 1 month. The nurse should use direct questions to evaluate which potential side effect? - Sexual dysfunction A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What information should be included in patient teaching? - It might be 2 weeks or more before you notice the effects of this medicine Patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking selective serotonin reuptake inhibitors (SSRIs), because TCAs: - Inhibit reuptake of norepinephrine and serotonin Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of: - Sodium Select the accurate information about the pharmacokinetics of lithium. - Excreted by the kidneys A patient with rapid-cycling bipolar disorder is not responding to lithium therapy. At the next multidisciplinary team meeting, the nurse should point out that many rapid-cycling bipolar patients have been effectively treated using: - Divalproex A patient diagnosed with mania begins lithium therapy on October 1. What is the earliest date a nurse can expect to see clinical improvement in the patient's condition? - October 8 A patient started diazepam (Valium) 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. This phenomenon results from: - Tolerance A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action? - Begin seizure precautions Which patient has the greatest risk for overdose with a benzodiazepine? A patient who: - Combines the drug with alcohol Most drugs used to treat Alzheimer's disease affect: - Cholinergic pathways, enzymes, and receptors Mr. Robbins is placed on quetiapine, which has the potential side effects of elevating cholesterol. Which laboratory test should you monitor related to this side effect? - Lipid profile Singer Michael Jackson allegedly abused alprazolam and propofol, an anesthetic. Which inference applies? - Potentially lethal sedation and CNS depression would be expected with this drug combination Monoamine oxidase inhibitors (MAOIs) can cause numbness, prickling, or tingling feelings, which are called: - Paresthesias The waiting time between stopping a monoamine oxidase inhibitor (MAOI) and starting a selective serotonin reuptake inhibitor (SSRI) is which of the following? - At least two weeks An acutely manic patient is started on divalproex. The experienced nurse understands valproate acid can be measured: - Through a serum blood level Mr. Jones, a client of yours is on a regimen of warfarin (Coumadin) because of a venous thrombosis (blood clot) which developed following his orthopedic surgery. Which of the following blood tests will he likely need as he is monitored during his treatment? - Prothrombin time/INR Anticoagulants are used to - Prevent the formation of blood clots Thrombolytic drugs are used to - Lyse a thrombus The most important food for a patient taking anticoagulants to avoid is - Garlic Fibrinolysis is the result of - Plasmin digesting the fibrin strands of clots How does clopidogrel prolong bleeding time? - Alters the plasma membrane of platelets Following an acute myocardial infarction, your patient is receiving alteplase (Activase), a thrombolytic drug. Which of the following adverse effects could be attributed to this drug administration? - Nosebleeds A patient taking Warfarin for atrial fibrillation is being checked for a therapeutic level of the drug in his system. His INR is expected to be: - Between 2-3 Laboratory studies related to heparin therapy include - aPtt Low molecular weight heparin - Has a longer duration of action and is more stable than heparin Match the drug with its classification. 1. Heparin 2. Clopidogrel 3. Aspirin (acetyl salycilate or ASA) 4. Aleplase, activase, TPA 5. Warfarin 6. Abciximab 7. Enoxaparin - 1. Anticoagulant 2. Antiplatelet 3. Antiplatelet 4. Thrombolytics 5. Anticoagulant 6. Antiplatelet 7. Anticoagulant Match the cholesterol lowering agent with patient teaching instructions for taking it. 1. Statins 2. Bile acid sequestrants 3. Niacin