Pharmacology W2

A nurse is caring for a patient who is taking propranolol (Inderal). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective? A) "I may have a very dry mouth while taking this drug." B) "I should never stop taking this drug abruptly but will taper the dose gradually." C) "I can stop walking a mile a day." D) "Since I am taking this drug, I no longer need to worry about my diet."

B) "I should never stop taking this drug abruptly but will taper the dose gradually."

Delta is an 88-year-old who has mild low back pain. What guidelines should be followed when prescribing pain management for Delta? A) Keep the dose of oxycodone low to prevent development of tolerance B) Acetaminophen is the first-line drug of choice C) Avoid prescribing NSAIDs D) Add in a short-acting benzodiazepine for a synergistic effect on pain

B) Acetaminophen is the first-line drug of choice ?

Jamie is a 5 month-old breastfed infant with a fever. Treatment for her fever may include: A) Baby aspirin B) Acetaminophen suppository C) Ibuprofen suppository D) Alternating acetaminophen and ibuprofen

B) Acetaminophen suppository

Regarding CYP23A4, how can they complicate drug therapy?

CYP23A4 changes drug offset and onset, leading to toxicity (due to differences in induction and inhibition). Hard to predict and complicates therapy.

Regarding CYP2C9 and VKORC1 and warfarin?

CYP2C9 + VKORC1: responsible for 40% of all differences in warfarin therapy require more time to achieve target INR and at more risk for bleeding, creates warfarin resistance

Adequate vitamin D is needed for: A. Absorption of calcium from the gastrointestinal tract B .Regulation of serum calcium levels C. Regulation of serum phosphate levels D.All of the above

D. All of the above

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur: A) At nighttime one to two times a month B) At nighttime three to four times a month C) Less than twice a week D) Daily

B) At nighttime three to four times a month

Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe? A) Levofloxacin B) Azithromycin C) Amoxicillin D) Doxycycline

B) Azithromycin

Goals when treating tuberculosis include: 1. Completion of recommended therapy 2. Negative purified protein derivative at the end of therapy 3. Completely normal chest x-ray 4. All of the above

1. Completion of recommended therapy

Anemia due to chronic renal failure is treated with: 1.Epoetin alfa (Epogen) 2.Ferrous sulfate 3.Vitamin B12 4.Hydroxyurea

1. Epoetin alfa (Epogen)

Kyle has Crohn's disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: 1.Oral folic acid 1 to 2 mg per day 2.Oral folic acid 1 gram per day 3.IM folate weekly for at least 6 months 4.Oral folic acid 400 mcg daily

1. Oral folic acid 1 to 2 mg per day

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

1. Sodium bicarbonate

Anaphylactic shock is a: 1.Type I reaction, called immediate hypersensitivity reaction 2.Type II reaction, called cytotoxic hypersensitivity reaction 3.Type III allergic reaction, called immune complex hypersensitivity 4.Type IV allergic reaction, called delayed hypersensitivity reaction

1. Type I, IgE-mediated (immediate, humoral immunity) 2. Type II, Cytotoxic (immediate, humoral immunity) 3. Type III, Immune-complex (immediate, humoral immunity 4. Type IV, Delayed Hypersensitivity (cell-mediated immunity)

pharmacognosy

is a part of pharmacology that uses the CHEMICALS FROM PLANTS, molds, fungi, insets, and marine animals for medicinal purposes.

Metabolism

is the CHEMICAL CHANGE of drug structure to enhance excretion, inactivate the drug, increase therapeutic action, activate a prodrug, and increase or decrease toxicity.

Absorption

is the MOVEMENT of a drug from its SITE of administration INTO the BLOOD

Distribution

is the MOVEMENT of absorbed drug in BODILY FLUIDS throughout the body to target tissues, with the requirement of adequate blood flow.

Phytomedicine

is the practice of using plants or plant parts to achieve a therapeutic cure.

Digoxin may cause a type A adverse drug reaction due to idiosyncratic effects its narrow therapeutic index being a teratogen being a carcinogen

its narrow therapeutic index

Regarding CYP2C9 and CYP2C92 and CYP2C93 and warfarin?

lower dosages in 2 and even more in 3

Reducing the prevalence of Tylenol overdose

lowering the recommended daily dosage on OTC labels to 3 g per day recommending providers only prescribe prescription acetaminophen combination drugs 325 mg per tablet or less

Define pharmacogenomics.

Study of identifying the genetic attributes of an individual that lead to variable response in drugs. Seeks to identify patterns of genetic variation that are employed to guide the design of ideal medication regimens for individuals

What does inhibtors, substrates and inducers of any CYP pathway do?

Substrate (drug that gets metabolized), Inducer (drug that increases metabolism of substrate-so low substrates levels can cause treatment failure), Inhibitor (drug that decreases metabolism of substrate-increase levels of substrate and cause toxicity)

You have provided patient teaching for a patient who has a new order for nadolol (Corgard) to treat their hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that your teaching has been effective?

"I should never stop taking this drug abruptly, but will taper the doses gradually."

An over-the-counter (OTC) drug has the following characteristics:

(1) it must be safe (the benefit must outweigh the risks), (2) it has low potential for misuse or abuse, (3) it can be labeled, (4) the patient must be able to self-diagnose the condition for which the drug is being taken, and (5) it must be for a condition that the patient can manage without supervision by a licensed health professional

Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include: 1. Older adults and those on fixed incomes 2. Patients with chronic illnesses 3. Patients with copayments for drugs on their insurance 4. Patients on public assistance

1. Older adults and those on fixed incomes

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 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

1. With a longer half-life so that missed doses produce a longer taper on the drug curve

The treatment of vitamin B12 deficiency is: 1. 1,000 mcg daily of oral cobalamin 2. 2 gm per day of oral cobalamin 3. Vitamin B12 100 mcg/day IM 4. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week

1. 1,000 mcg daily of oral cobalamin

An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally

1. Absorbed rapidly

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

1. Bioavailability issues are especially important for drugs with narrow therapeutic

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 and 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 and pads of paper, from the pharmaceutical representative

1.Conflicts of interest and financial relationships should be disclosed by those providing education.

Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of Pediatrics recommends that all newborns receive: 1.IM vitamin K (phytonadione) within 24 hours of birth 2.Oral vitamin K supplementation in the first 3 weeks of life 3.Formula containing vitamin K or breast milk 4.Oral vitamin K in the first 24 hours after birth

1.IM vitamin K (phytonadione) within 24 hours of birth

It is reasonable to add ___________ to a Helicobacter pyloritreatment regimen to improve eradication rates of H. pylori. 1.Probiotics 2.Omega-3 fatty acids 3.Plant sterols 4.Fiber

1.Probiotics

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 and 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 and pharmacological terms

2. Their concerns and specific area of knowledge deficit were addressed

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.

2. A rich blood supply to the area of absorption leads to better absorption.

Ultra-rapid metabolizers of drugs may have: 1.To have dosages of drugs adjusted downward to prevent drug accumulation 2.Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 3.Increased elimination of active, nonmetabolized drug 4.Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug

2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure

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

2. After four to five half-lives

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

2. Are harmful if taken in higher than recommended amounts

Under new U.S. Food and 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 and clinical considerations on the drug label 3. Eliminated, and 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

2. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label

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

2. Half-life

Patients who are being treated for folate deficiency require monitoring of: 1.Complete blood count every 4 weeks 2.Hematocrit and hemoglobin at 1 week and then at 8 weeks 3.Reticulocyte count at 1 week 4.Folate levels every 4 weeks until hemoglobin stabilizes

2. Hematocrit and hemoglobin at 1 week and then at 8 weeks

Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and 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

2. Is modified by the concurrent administration of another drug

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?scheduled drugs which require a DEA license to prescribe .All opiates are scheduled drugs which require a DEA license to prescribe. 2.Opiates stimulate only mu receptors for the control of pain. 3.Most of the adverse effects of opiates are related to mu receptor stimulation. 4.Naloxone is an antagonist to opiates.

2. Opiates stimulate only mu receptors for the control of pain.

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 and Drug Administration Center for Drug Evaluation and Research 3.The U.S. Drug Enforcement Administration 4.MedWatch

2. The U.S. Food and Drug Administration Center for Drug Evaluation and Research

Which of the following statements about the major distribution barriers (blood- brain or fetal-placental) is true? 1. Water soluble and ionized drugs cross these barriers rapidly. 2. The blood-brain barrier slows the entry of many drugs into and 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 and are safe for pregnant women.

2. The blood-brain barrier slows the entry of many drugs into and from brain cells.

Infants and young children are at higher risk of developing antibiotic-resistant infections due to: 1. Developmental differences in pharmacokinetics of the antibiotics in children 2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children 3. Parents of young children insisting on preventive antibiotics so they don't miss work when their child is sick 4. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children

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

2. When the amount of drug in the body remains constant

There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well-documented: 1.Concern for developing cardiac dysrhythmias 2.Anti-inflammatory effects 3.Total cholesterol-lowering effects 4.Effects on fasting blood sugar

2.Anti-inflammatory effects

There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s): 1.Asthma 2.Autism 3.Arthritis 4.All of the above

2.Autism

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 Image of page 7

2.Be patient-centered'

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 and side effects

2.Biological half-life

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

2.Concentration will produce an adverse response

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

2.Discussion of expected adverse drug reactions

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

2.Individualize the drug choice for the specific patient

14.________ should be monitored when vitamin B12 therapy is started. 1.Serum calcium 2.Serum potassium 3.Ferritin 4.C-reactive protein

2.Serum potassium Plasma potassium often falls transiently when severe anemias respond to cobalamin (or iron), but its clinical relevance has never been proven.

According to the 2003-2006 National Health and Nutrition Examination Survey study of dietary intake, the group at highest risk for inadequate calcium intake was: 1.The elderly (over age 60 years) 2.Teenage females 3.Teenage males 4.Preschoolers

2.Teenage females females in the 9- to 13-year-old and 14- to 18-year-old groups

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 and it is not being used for a life-threatening condition 2.Will be taken twice daily and will be taken at home 3.Is expensive, but covered by health insurance 4.None of these are important in choosing a drug

2.Will be taken twice daily and will be taken at home

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 and dizziness 4. Must be taken no more than twice a day

3. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness

Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? 1. 40 mcg/day 2. 200 mcg/day 3. 800 mcg/day 4. 2 gm/day

3. 800 mcg/day

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

3. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history

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

3. An exaggerated response if the drug is withdrawn

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 and 2 4. Neither 1 nor 2

3. Both 1 and 2

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: 1. Renal excretion is similar in both classes of drugs. 2. When these drug classes are metabolized in the liver they both produce resistant enzymes. 3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. 4. There is not an issue with cross-resistance between the penicillins and cephalosporins.

3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

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 and polar to facilitate excretion

3. Change drug molecules to a form that an excretory organ can excrete

Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: 1.Take the iron with milk if it upsets her stomach. 2.Antacids may help with the nausea and GI upset caused by iron. 3.Increase fluids and fiber to treat constipation. 4.Iron is best tolerated if it is taken at the same time as her other medications

3. Increase fluids and fiber to treat constipation.

The first-line therapy for mild-persistent asthma is: 1. High-dose montelukast 2. Theophylline 3. Low-dose inhaled corticosteroids 4. Long-acting beta-2-agonists

3. Low-dose inhaled corticosteroids

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

3. Prescribing a third drug to counteract the adverse reaction of the combination

The dosage of Vitamin B12 to initially treat pernicious anemia is: 1. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month 2. Vitamin B12 IM monthly 3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month 4. Oral cobalamin 1,000 mcg daily

3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month

A patient with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency? 1.Vitamin B12 2.Vitamin C 3.Folate 4.Niacine

3.Folate

Symptoms of folate deficiency include: 1.Thinning of the hair 2.Bruising easily 3.Glossitis 4.Numbness and tingling of the hands and feet

3.Glossitis

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 and active 4.Are most common in collagen tissues

3.Increase the length of time a drug is available and active

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

3.Onset of action

It is reasonable to recommend supplementation with _________ in the treatment of hyperlipidemia. 1.Omega-3 fatty acids 2.Probiotics 3.Plant sterols 4.Calcium

3.Plant sterols

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to 1.Ensure the patient will not have increased adverse drug reactions to the tamoxifen 2.Identify potential drug-drug interactions that may occur with tamoxifen 3.Reduce the likelihood of therapeutic failure with tamoxifen treatment 4.Identify poor metabolizers of tamoxifen

3.Reduce the likelihood of therapeutic failure with tamoxifen treatment

Regarding CYP2D6, what to keep in mind about the population at large?

35% of the population has a non functionig CYP2D6, won't work

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.

4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.

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."

4. "To achieve best effect, take the tablet with at least 8 ounces of fluid."

Providers should use an antibiogram when prescribing. An antibiogram is: 1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics 2. An algorithm used for prescribing antibiotics for certain infections 3. The reference also known as the Pink Book, published by the Centers for Disease Control 4. A chart of the local resistance patterns to antibiotics developed by laboratories

4. A chart of the local resistance patterns to antibiotics developed by laboratories

Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. Additive

4. Additive

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 mostprescription benefit plans do notcover generics 3. Market the drug to a whole newpopulation, as they are able tomarket to patients instead of just providers 4. Continue to make large profits from their blockbuster brand-name drug

4. Continue to make large profits from their blockbuster brand-name drug

An agonist activates a receptor and 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

4. Downregulate the numbers of that specific receptor

Factors that place a patient at risk of developing an antimicrobial-resistant organism include: 1. Age over 50 years 2. School attendance 3. Travel within the U.S. 4. Inappropriate use of antimicrobials

4. Inappropriate use of antimicrobials

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 and 2 4. Neither 1 nor 2

4. Neither 1 nor 2

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 and 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

4. Unbinding a nonvolatile drug from plasma proteins

Before beginning IM vitamin B12 therapy, which laboratory values should be obtained? 1.Reticulocyte count, hemoglobin, and hematocrit 2.Iron 3.Vitamin B12 4.All of the above

4.All of the above

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 and weekends 4.All of the above

4.All of the above

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 drug must: 1.Be safe and 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

4.All of the above

Probiotics are recommended to be co-administered when ____________ are prescribed: 1.Antacids 2.Antihypertensives 3.Antidiarrheals 4.Antibiotics

4.Antibiotics

Patients with iron deficiency will develop: 1.Hemolytic anemia 2.Megaloblastic anemia 3.Macrocytic-hypochromic anemia 4.Microcytic-hypochromic anemia

4.Microcytic-hypochromic anemia

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include: The maximum time varenicline can be used is 12 weeks. 2.Nausea is a sign of varenicline toxicity and should be reported to the provider. 3.The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date. 4.Neuropsychiatric symptoms may occur.

4.Neuropsychiatric symptoms may occur.

There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient? 1.Vitamin B1 (thiamine) 2.Vitamin B2 (riboflavin) 3.Calcium 4.Omega-3 fatty acids

4.Omega-3 fatty acids

Phenytoin requires that a trough level be drawn. Peak and 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 and saturation of receptor sites 4.To determine if a drug is in the therapeutic range

4.To determine if a drug is in the therapeutic range

Regarding CYP23A4, they are responsible for how much of drug metabolism of ALL DRUGS?

50%

Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: 18 mg/day of iron supplementation 6 mg/kg per day of elemental iron 325 mg ferrous sulfate per day 325 mg ferrous sulfate TID

6 mg/kg per day of elemental iron

Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):1. A 32-year-old male A 22-year-old female A 3-month-old female A 48-year-old male

A 3-month-old female

Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? A) A 47-year-old female with hypertension B) A 52-year-old male with adult-onset diabetes C) A 17-year-old female with symptoms of an upper respiratory infection D) A 62-year-old male with gout

A) A 47-year-old female with hypertension

Nicholas is a football player who presents to clinic with athlete's foot. Patients with tinea pedis may be treated with: A) OTC miconazole cream for 4 weeks B) Oral ketoconazole for 6 weeks C) Mupirocin ointment for 2 weeks D) Nystatin cream for 2 weeks

A) OTC miconazole cream for 4 weeks

The American Dietetic Association (ADA) has recommended the use of specific nutritional supplements in the following population(s): A.400 IU per day of vitamin D in all infants and children B.1000 IU per day of vitamin D for all pregnant women C.60 mg per day of iron for all adults over age 50 years D.All of the above

A. 400 IU per day of vitamin D in all infants and children

Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: A.Antihypertensives, diuretics, and digoxin B.Antidiarrheals, antihistamines, and omeprazole Image of page 24 C.Penicillin antibiotic class and benzodiazepines D.None of the above

A. Antihypertensives, diuretics, and digoxin ++corticosteroids, loratadine, procainamide, quinidine, and spironolactone Pt's should be warned against excessive and chronic use, especially when it is combined with diuretics. Licorice candy does not actually contain the herb but rather licorice flavoring

The OTC antidiarrheal bismuth subsalicylate (Pepto Bismol) is recommended: A.As traveler's diarrhea prophylaxis B.For all children with diarrhea C.To be combined with aspirin to be the most effective D.To be stopped immediately if blackened stool occurs

A. As traveler's diarrhea prophylaxis

General responsibility of the nurse regarding genetics may include which of these activities? (Select all that apply.) A. Assessing the patient's personal and family history B. Referring the patient to a genetic counselor or other genetic specialist C. Communicating the results of genetic tests to the patient and patient's family D. Maintaining privacy and confidentiality during the testing process E. Answering questions about genetic test results

A. Assessing the patient's personal and family history B. Referring the patient to a genetic counselor or other genetic specialist D. Maintaining privacy and confidentiality during the testing process

Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to: A.Cardiac disturbances B.Central nervous system depression C.Respiratory depression D.Skin rashes

A. Cardiac disturbances

The nurse is assessing a patient for a possible increased risk for genetic disorders. Which of these, if present, may indicate an increased risk of genetic disorders? (Select all that apply.) A. Having a brother who died of a miocardio infarction at age 29 B. Having a family member who has been diagnosed with more than one type of cancer C. Having an uncle who is diagnosed with prostate cancer at age 73 D. A history of allergy to shellfish and iodine E. Having a maternal grandmother, two maternal aunts, and a sister who were diagnosed with colon cancer

A. Having a brother who died of a MI at age 29 B. Having a family member who has been diagnosed with more than one type of cancer E. Having a maternal grandmother, two maternal aunts, and a sister who were diagnosed with colon cancer

Azithromycin dosing requires the first day's dose be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: A.Rapidly achieves drug levels in the therapeutic range B.Requires four to five half-lives to attain C.Is influenced by renal function D.Is directly related to the drug circulating to the target tissues

A. Rapidly achieves drug levels in the therapeutic range

Milk and other foods that alkalinize the urine may: A.Result in basic drugs being reabsorbed in the renal tubule B.Increase the elimination of basic drugs in the urine C.Decrease the elimination of acidic drugs D.Not alter drug elimination due to the minimal change in urine pH

A. Result in basic drugs being reabsorbed in the renal tubule

Patients who have a poor metabolism phenotype will have: A.Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug B.Accumulation of inactive metabolites of drugs C.A need for increased dosages of medications D.Increased elimination of an active drug

A. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug

The nurse is explaining the general goal of gene therapy to a patient. With gene therapy, the general goal is to transfer Exogenous genes to a patient for which result? A. To change the patient's own genetic functioning to treat a given disease B. To improve drug metabolism C. To prevent genetic disorders in the patient's future children D. To stimulate the growth of stem cells

A. To change the patient's own genetic functioning to treat a given disease

A patient's nutritional intake and lab work reflects hypoalbuminemia. This is critical to prescribing because: A.Distribution of drugs to target tissue may be affected B.The solubility of the drug will not match the site of absorption C.There will be less free drug available to generate an effect D.Drugs bound to albumin are readily excreted by the kidney

A.Distribution of drugs to target tissue may be affected

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: A.Get worse B.Get better C.Not be adequately treated D.Need additional herbs to treat the yang

A.Get worse

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? A.Increasing copayments for care B.Unrestricted formularies for drugs including brand names C.Increasing the number of people who have access to care D.Treating a wider range of disorders

A.Increasing copayments for care

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 suggestthat he might not be adherent? A.Ralph states that he always takes the drug "when I feel my pressure is going up." B.Ralph contacts his NP to discuss the need to increase the dose. C.Ralph consistently keeps his follow-up appointments to check his blood pressure. D.All of the above show that he is adherent to the drug regimen.

A.Ralph states that he always takes the drug "when I feel my pressure is going up."

Adverse drug reactions and patients' perceptions of them are likely to produce non-adherence. Which of the following ADRs are least likely to produce non-adherence? A.Severe hypotension and anaphylaxis B.Constipation and diarrhea C.Headache and dizziness D.Nausea and vomiting

A.Severe hypotension and anaphylaxis

Patients taking warfarin need to be educated about the vitamin K content of foods to avoid therapeutic failure. Foods high in vitamin K that should be limited to no more than one serving per day include: A.Spinach B.Milk C.Romaine lettuce D.Cauliflower

A.Spinach

New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do. A.True B.False

A.True

Changes in the individual pharmacokinetic parameters of adsorption, distribution, or elimination may result in high concentrations of the drug in the body, leading to which type of adverse drug reaction? A.Type A B.Type C C.Type D D.Type E

A.Type A

Isoniazid (INH) may induce a deficiency of which vitamin? A.Vitamin B6 B.Vitamin C C.Vitamin D D.Vitamin E

A.Vitamin B6 AKA pyridoxine Given prophylactically to patients on isoniazid to prevent drug-induced neuritis. Vitamin B6 supplements may reduce the symptoms of premenstrual syndrome, and nausea and vomiting associated with pregnancy

ADME or MADME

Absorption Distribution Metabolism Excretion

Brad was diagnosed with an acute midshaft radial/ulnar fracture. He was prescribed Hydrocodone in the emergency room, and Tramadol by the orthopedic physician, He states has been taking both of the medications, It this situation, two different pain meds are given together for pain relief. The drug-drug interaction is: A) Synergistic B) Antagonistic C) Potentiative D) Additive

Additive?

The elderly are at high risk of ADRs due to: Having greater muscle mass than younger adults, leading to higher volume of distribution The extensive studies that have been conducted on drug safety in this age group The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect Age-related decrease in renal function

Age-related decrease in renal function

Factors that explain and predict medication adherence include: 1. Social 2. Financial 3. Health system 4. All of the above

All of the above

Monitoring adherence can take several forms, including: 1. Patient reports from data in a drug diary 2. Pill counts 3. Laboratory reports and other diagnostic markers 4. All of the above

All of the above

The therapeutic goals when prescribing include(s) 1.Curative 2.Palliative 3.Preventive 4.All of the above

All of the above

Propranolol (Inderal) is used extensively as treatment for what condition?

Angina

Vanessa is a 19-year-old female who calls the advice nurse worried that a condom broke yesterday when she was having intercourse. She reports a normal menses 10 days ago. One recommendation for care is

B

Common OTC pain relievers such as acetaminophen or ibuprofen: :Are always safer for the patient than prescription pain medication Are harmful if taken in higher-than-recommended amounts Have minimal interaction with prescription medications Should never be given to children unless recommended by theirprovider

Are harmful if taken in higher-than-recommended amounts

Regarding CYP2D6, who are the ultrarapid metabolizers?

Asians using SSRIs, you need to give a higher dose

Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment? A) Mupirocin (Bactroban) B) Bacitracin and polymixin B (generic double antibiotic ointment) C) Retapamulin (Altabax) D) Oral cephalexin (Keflex)

B) Bacitracin and polymixin B (generic double antibiotic ointment)

Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers due to: A) There may be an antagonistic reaction between the two B) The additive effects may include bradycardia C) They may potentiate each other and cause respiratory depression D) The additive effects may cause metabolic acidosis

B) The additive effects may include bradycardia

Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? A. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. B. Additive antimuscarinic effects may occur with antihistamines. C. Cholinergic blockers may decrease the sedative effects of hypnotics. D. Cholinergic blockers are contraindicated with antipsychotics.

B. Additive antimuscarinic effects may occur with antihistamines.

The ailment that generates the greatest over-the-counter annual drug sales is: A.Constipation B.Cough and colds C.Heartburn D.Acute and chronic pain

B. Cough and colds

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: A.Toxic levels of warfarin building up B.Decreased response to warfarin C.Increased risk for significant drug interactions with warfarin D.Less risk of drug interactions with warfarin

B. Decreased response to warfarin Genetic testing for VCORC1 mutation to assess potential warfarin resistance is RECOMMENDED prior to prescribing Warfarin In humans, mutations in this gene can be associated with deficiencies in vitamin-K-dependent clotting factors.

The NIH Recombinant DNA Advisory Committee has what responsibility? A. Approving all forms of human clinical gene therapy B. Identifying all major risk to the human subjects in a specific research protocol C. Reviewing clinical trials involving human gene transfer D. Analyzing genomes and determining whether they appear mutagenic

B. Identifying all major risk to the human subjects in a specific research protocol

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to: A.Decreased effectiveness of irinotecan in the treatment of cancer B.Increased adverse drug reactions, such as neutropenia C.Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 D.Increased concerns for irinotecan being carcinogenic

B. Increased adverse drug reactions, such as neutropenia

Which is the most appropriate example of a product formed by an indirect form of gene therapy? A. Stem cells B. Insulin C. Antigen substitution D. Platelet inhibitors

B. Insulin

Ginseng, which is taken to assist with memory, may potentiate (INCREASE POWER) A.Aricept B.Insulin C.Digoxin D.Propranolol

B. Insulin Some studies found it decreased fasting blood sugar and hemoglobin to such a degree that some diabetics no longer needed insulin. It may potentiate insulin and oral hypoglycemics, and it interacts with MAOIs to cause headaches, tremors, and mania.

Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount? A.Iron B.Vitamin A C.Vitamin B6 D.Vitamin C

B. Vitamin A deficiency is rare in the US, and only used for chronic alcoholics and patients with malabsorption problems (cystic fibrosis) found in Liver, dairy products, fish, darkly colored fruits and leafy vegetables

Drugs that are receptor antagonists, such as beta blockers, may cause: A.Down-regulation of the drug receptor B.An exaggerated response if abruptly discontinued C.Partial blockade of the effects of agonist drugs D.An exaggerated response to competitive drug agonists

B.An exaggerated response if abruptly discontinued

Drugs administered via intravenous (IV) route: A. Need to be lipid soluble in order to be easily absorbed B.Begin distribution into the body immediately C.Are easily absorbed if they are nonionized D.May use pinocytosis to be absorbed

B.Begin distribution into the body immediately

A laboratory result indicates the peak level for a drug is above the minimum toxic concentration. This means that the A.Concentration will produce therapeutic effects B.Concentration will produce an adverse response C.Time between doses must be shortened D.Duration of action of the drug is too long

B.Concentration will produce an adverse response

Herbs and supplements are regulated by the Food and Drug Administration. A.True B.False

B.False

When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is A.The sum of the effects of each drug individually B.Greater than the sum of the effects of each drug individually C.Less than the effect of each drug individually D.Not predictable, as it varies with each individual

B.Greater than the sum of the effects of each drug individually

Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: A.Herbs which are yang in nature B.Herbs that are yin in nature C.Ginger D.Golden seal

B.Herbs that are yin in nature

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: A.A need to monitor drugs metabolized by 2D6 for toxicity B.Increased dosages needed of drugs metabolized by 2D6, such as the SSRIs C.Decreased conversion of codeine to morphine by CYP 2D6 D.The need for lowered dosages of drugs, such as beta blocker

B.Increased dosages needed of drugs metabolized by 2D6, such as the SSRIs

Infants and young children are at higher risk of ADRs due to: A.Immature renal function in school-age children B.Lack of safety and efficacy studies in the pediatric population C.Children's skin being thicker than adults, requiring higher dosages of topical medication D.Infant boys having a higher proportion of muscle mass, leading to a higher volumeof distribution

B.Lack of safety and efficacy studies in the pediatric population

Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent: A.Beriberi B.Peripheral neuropathy C.Rickets D.Megaloblastic anemia

B.Peripheral neuropathy

Vitamin B2 (riboflavin) may be prescribed to: A.Decrease the incidence of beriberi B.Reduce headaches and migraines C.Prevent pernicious anemia D.Treat hyperlipidemia

B.Reduce headaches and migraines SEEN IN: alcoholics, anorexic patients, and those with lactose intolerance who cannot drink milk MigreLief, an over-the-counter product that contains feverfew, RIBOFLAVIN, MG (25-400mg)

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes

BUN, Creatinine, and Creatinine clearance

Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: A) Azithromycin B) Trimethoprim/sulfamethoxazole C) Ceftriaxone D) Ciprofloxacin

C) Ceftriaxone

Long-acting beta-agonists (LTBAs) received a Black Box warning from the U.S. Food and Drug Administration due to the: A) Risk of life-threatening dermatological reactions B) Increased incidence of cardiac events when LTBAs are used C) Increased risk of asthma-related deaths when LTBAs are used D) Risk for life-threatening alterations in electrolytes

C) Increased risk of asthma-related deaths when LTBAs are used

Dysmennorhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is: A) Oral contraceptive pills B) Caffeine C) NSAIDs D) Aspirin

C) NSAIDs

Martin is a 60 year old with hypertension. The first-line decongestant to prescribe would be: A) Oral pseudoephedrine B) Oral phenylephrine C) Nasal oxymetazoline D) Nasal azelastine

C) Nasal oxymetazoline is used for the temporary relief of nasal (of the nose) congestion or stuffiness caused by hay fever or other allergies, colds, or sinus trouble.

A nurse receives an order for clonidine (Catapres) for a child. Which of the following would be the most appropriate action by the nurse? A) Weigh the patient to get the correct body surface area. B) Have a second nurse check the dose before administering the drug. C) Question the order because the patient is not receiving any other antihypertensives. D) Make sure the patient is on a cardiac monitor.

C) Question the order because the patient is not receiving any other antihypertensives.

Factors that affect gastric drug absorption include: A.Liver enzyme activity B.Protein-binding properties of the drug molecule C.Lipid solubility of the drug D.Ability to chew and swallow

C. Lipid solubility of a drug

Pharmacogenetic testing is required by the Food and Drug Administration (FDA) prior to prescribing: A.Erythromycin B.Digoxin C.Cetuximab D.Rifampin

C. Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor used for the treatment of metastatic colorectal cancer, metastatic non-small cell lung cancer and head and neck cancer.

The role of the NP in the use of herbal medication is to: A.Maintain competence in the prescribing of common herbal remedies B.Recommend common over-the-counter herbs to patients C.Educate patients and guide them to appropriate sources of care D.Encourage patients to not use herbal therapy due to the documented dangers

C. Educate patients and guide them to appropriate sources of care

The presence of certain factors in a person's genetic makeup and increases the likelihood of eventually developing one or more diseases is known as a A. Genetic mutation B. Genetic polymorphism C. Genetic predisposition D. Genotype

C. Genetic predisposition

The nurse is reviewing gene therapy. Which is a commonly studied adenovirus? A. Hepatitis A and C virus B. Genovirum C. Human influenza virus D. Pallodium

C. Human inFLUenza virus Is a non enveloped, double stranded DNA Virus rhinovirus (30-50%), coronavirus (10-15%) influenza virus (5-15%) human parainfluenza viruses human RSV adenoviruses, enteroviruses and metapneumovirus. In total over 200 serologically different viral types cause colds.

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: A.Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele B.Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele C.Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele D.Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine

C. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele TOXIC EPIDERMAL NECROLYSIS Early symptoms of S/S include fever and flu-like symptoms. A few days later the skin begins to blister and peel forming painful raw areas. Mucous membranes, such as the mouth, are also typically involved

Rifampin is a nonspecific CYP450 inducer that may: A.Lead to toxic levels of rifampin and must be monitored closely B.Cause toxic levels of drugs, such as oral contraceptives, when co-administered C.Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure D.Cause nonspecific changes in drug metabolism

C. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure

Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following nutrients? A.Protein B.Calcium C.Iron D.Vitamin K

C. Iron

When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: A. Not to take their regularly prescribed medications while on these antibiotics B. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption C. Not to take antacids while on these medications, as the antacid decreases absorption D. That there are no drug interactions with these antibiotics

C. Not to take antacids while on these medications, as the antacid decreases absorption should not take any antacid until at least 2 hours after tetracycline administration Aluminum hydroxide and magnesium hydroxide have a strong affinity for tetracycline and form an insoluble and inactive chelate. This interaction can reduce the bioavailability of tetracycline by 90% and result in clinical failures doxycycline (tetracycline) cipro (quinolone)

Prazosin (Minipress) has just been prescribed for your patient who has hypertension. To avoid the first dose phenomenon, you should plan to administer the drug: A. with a full glass of water B. early in the day C. at bedtime D. with meals

C. at bedtime orthostatic hypotension, pass out. 1-3 hours after taking first dose, therefore usually give at bedtime.

The standard dosage of St John's Wort for the treatment of mild depression is: A.300 mg daily B.100 mg three times a day C.300 mg three times a day D.600 mg three times a day

C.300 mg three times a day

The American Dietetic Association (ADA) recommends pregnant women take a supplement including: A.1000 IU daily of vitamin D B.2.4 mcg/day of vitamin B12 C.600 mcg/day of folic acid D.8 mg/day of iron

C.600 mcg/day of folic acid Women of childbearing age need 400 mcg/day of folic acid. Pregnant women need 600 mcg/day of folic acid, a multivitamin/mineral supplement, 27 mg/day of iron (60 mg/d if patient is anemic), and vitamin B12 if the patient is vegan or lacto-ovo-vegetarian. FOLATE: Enriched cereal grains, dark leafy vegetables, enriched and whole-grain breads and bread products, fortified ready-to-eat cereals

Drugs that have a significant first-pass effect: A.Must be given by the enteral (oral) route only B.Bypass the hepatic circulation C.Are rapidly metabolized by the liver and may have little if any desired action D.Are converted by the liver to more active and fat-soluble forms

C.Are rapidly metabolized by the liver and may have little if any desired action

Which of the following factors may adversely affect a patient's adherence to a therapeutic drug regimen? A.Complexity of the drug regimen B.Patient perception of the potential adverse effects of the drugs C.Both A and B D.Neither A nor B

C.Both A and B

Drugs that are receptor agonists may demonstrate what property? A.Irreversible binding to the drug receptor site B.Up-regulation with chronic use C.Desensitization or down-regulation with continuous use D.Inverse relationship between drug concentration and drug action

C.Desensitization or down-regulation with continuous use Agonists, or full agonists, are drugs that produce receptor stimulation and a conformational change every time they bind.

Non-adherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of non-adherence to these drugs is to prescribe a drug that: A.Has a short half-life so that missing one dose has limited effect B.Requires several dosage titrations so that missed doses can be replaced with lower Image of page 13 doses to keep costs down. C.Has a tolerability profile with less of the adverse effects that are considered "irritating," such as nausea and dizziness

C.Has a tolerability profile with less of the adverse effects that are considered "irritating," such as nausea and dizziness

Phenytoin decreases folic acid absorption by: A.Altering the pH of the stomach B.Increasing gastric emptying time C.Inhibiting intestinal enzymes required for folic acid absorption D.Chelation of the folic acid into inactive ingredients

C.Inhibiting intestinal enzymes required for folic acid absorption

When melatonin is used to induce sleep, the recommendation is the patient: A.Take 10 mg 30 minutes before bed nightly B.Take 1 to 5 mg 30 minutes before bed nightly C.Not take melatonin more than three nights a week D.Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep

C.Not take melatonin more than three nights a week

Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: A.Respiratory depression B.Cardiac disturbance C.Salicylates poisoning D.Life-threatening rashes

C.Salicylates poisoning (bark of Gaultheria procumbens and methyl salicylate) analgesic and anti-inflammatory effects of the salicylate Allergic to aspirin or taking oral anticoagulants should NOT use

There is strong evidence to support that adequate vitamin C intake prevents: A.The common cold B.Breast cancer C.Scurvy D.All of the above

C.Scurvy

Elena Vasquez' primary language is Spanish and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? A.Use correct medical terminology since Spanish has a Latin base B.Use a family member who speaks more English to act as interpreter C.Use a professional interpreter or a reliable staff member who can interpret D.Use careful, detailed explanations

C.Use a professional interpreter or a reliable staff member who can interpret

The American Heart Association (AHA) and the ADA recommend a minimum daily fiber intake of ____ for cardiovascular health: A.10 mg/day B.15 mg/day C.20 mg/day D.25 mg/day

D. 25 mg/day

Smokers are at risk for vitamin C deficiency. It is recommended that smokers take ____ vitamin C supplement. A.100 mg/day B.500 mg/day C.1000 mg/day D.35 mg/day more than nonsmokers

D. 35 mg/day more than nonsmokers Smokers and those heavily exposed to secondary smoke have decreased vitamin C levels (also dialysis patients)

Sadie's adult daughter reports that when Sadie (age 84 years) takes Tylenol PM (acetaminophen and diphenhydramine) to help her sleep she has "strange dreams" including wandering and thinking she is at her childhood home. You understand: A.This is a sign of early dementia and she should undergo cognitive testing B.Sadie is not taking an effective dose to help her stay asleep C.Sadie is exhibiting signs of an allergic reaction to the diphenhydramine in the Tylenol PM D.Delirium is a common adverse reaction seen when elderly patients take diphenhydramine

D. Delirium is a common adverse reaction seen when elderly patients take diphenhydramine

Inhibition of P-glycoprotein by a drug such as quinidine may lead to: A.Decreased therapeutic levels of quinidine B.Increased therapeutic levels of quinidine C.Decreased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination D.Increased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

D. Increased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

In Ayurvedic medicine treatment is based on the patient's dominant dosha, which is referred to as the person's: A.Vata B.Pitta C.Kapha D.Prakriti

D. Prakriti practiced in India, is one of the oldest systems of medicine in the world

Digoxin levels need to be monitored closely when the following medication is started: A.Loratadine B.Diphenhydramine C.Ipratropium D.Albuterol

D.Albuterol may decrease digoxin levels

Patients need to be instructed regarding the drug interactions with St John's Wort, including: A.MAO inhibitors (MAOIs) B.Serotonin reuptake inhibitors (SSRIs) C.Over-the-counter (OTC) cough and cold medications D.All of the above

D.All of the above Can cause serotonin syndrome. St. John's wort may decrease digoxin, phenytoin, and cyclosporine levels leading to therapeutic failure. Wafarin's effectiveness may be decreased

According to the World Health Organization Classification, Type B adverse reactions are: A.When a drug is a teratogen B.When a drug is carcinogenic C.A delayed ADR, such as renal failure D.An allergic or idiosyncratic response

D.An allergic or idiosyncratic response

Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug? A.Stand facing him and speak slowly and clearly B.Speak in low tones or find a provider who has a lower voice C.Write down the instructions as well as speaking them D.If he reads lips, exaggerate lips movements when pronouncing the vowel sounds

D.If he reads lips, exaggerate lips movements when pronouncing the vowel sounds

Vitamin B12 deficiency may lead to: A.Hair loss B.Insomnia C.Dry scales on the scalp D.Numbness and tingling of the hands

D.Numbness and tingling of the hands

The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: A.Requires all providers screen their patients for methamphetamine use B.Restricts the prescribing of amphetamines to U.S. citizens C.Requires a prescription be written for all methamphetamine precursors in all states D.Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales

D.Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales

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? A.Financial status B.Mobility C.Social support D.Sexual practices

D.Sexual practices

Rational Drug Selection

DEFINING what the patient's problem is SPECIFYING the therapeutic objective, COLLABORATION with the patient, CHOOSING the treatment, EDUCATING the patient, MONITORING the effectiveness.

The influence of PGP is most important with which drug?

Digoxin. PGP can be inhibited by quininidine. Digoxin level will rise

What test to use for carbamzepine and asians?

HLA-B*1052 allele if positive, higher risk of steven-johnson syndrome and toxic epidermal necrosis

Gender differences between men and women in pharmacokinetics include: More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations Slower organ blood flow rates so that drugs tend to take longer to be excreted

Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

Regarding CYP2D6 and codeine?

If you are UM and breastfeed, you may depress infants respiratory function. Black box warning for codeine in post op surgery (pedi)

Sarah developed a rash after using a topical medication. This is a type .....allergic drug reaction? I II III IV

IV

perenteral

IV IM SQ

Where is CYP located?

In humans CYP is located In ER and mitochondria, bind In greater amounts In liver and intestine and lesser amounts In skin, brain, lungs, kidneys

Describe alleles of poor metaboliers (PM).

Lack an enzyme

Infants and young children are at higher risk of ADRs due to: o Immature renal function in schoolage children o Lack of safety and efficacy studies in the pediatric population o Children's skin being thicker than adults, requiring higher dosages of topical medication o Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution

Lack of safety and efficacy studies in the pediatric population

PGP are responisble for what 2 very bad things?

Multidrug resistance and chemotherapy resistance in cancer

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 and affluent 2. Have chronic conditions 3. Self-monitor drug effects on their symptoms 4. None of the above guarantee adherence

None of the above guarantee adherence

A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) for hypertension. What would the nurse teach the patient regarding the possible drug-to-drug interactions and what the patient is advised to avoid? A)Antibiotics B)Oral contraceptives C)NSAIDs D)Antifungal agents

Nonsteroidal anti-inflammatory drugs (NSAIDs) The beneficial effects of your beta-blocker may decrease and cause an increase in your blood pressure.

What is a P glycoprotein (PGP)?

PGP is a protein bound ATP dependent transport system responsible for the efflux of xenobiotics from the cell to extracellular fluid (takes synthetic stuff out of cell)

Enteral

PO Most convenient and preferred route Safer than parenteral

What type of metabolism utilizes conjugation reactions?

Phase II metabolism

Azithromycin dosing requires the first days dose be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: A) Rapidly achieves drug levels in the therapeutic range B) Requires four to five half-lives to attain C) Is influenced by renal function D) Is directly related to the drug circulating to the target tissues

Rapidly achieves drug levels in the therapeutic range

What factors affect absorption?

Rate of dissolution Route Surface area Blood flow to area Lipid solubility pH First pass effect

Calcium channel blockers and high dose steroids are what kind of inhibitors with PGP?

Reversible Inhibitors

??? are the most likely to be hospitalized due to adverse effects associated with OTC medication use

The elderly

Chapter 2 - Review of Basic Principles of Pharmacology

The rational use of drugs is based on a foundation of chemical and physiological principles. Drugs interact with specific sites, called receptors, according to chemical laws; higher concentrations of drug produce more interactions and greater effects. How rapidly a drug is absorbed, distributed, metabolized, and excreted dictates local concentrations of drug that produce effects. The onset and duration of a drug effect reflect the pharmacokinetics of the drug and the properties of the receptor. Sound therapeutic decisions draw upon the unifying foundational principles of pharmacology.

All OTC drugs have the following characteristics:

They must be safe They have low potential fpr misuse or abuse They have the ability to be managed just by the patient They can be labeled The patient must have the ability to self-diagnose the condition

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

Toxicity

What 4 drugs require genetic testing before adminstration?

Trastuzumab (breast cancer HER2+), Cetuximab (EGFR+), Maraviroc (CCR-5 Tropic HIV 1 diagnosis required), Dasatinib (Philadelphia Positive)

What genetic test to use for irnotectan?

UGT1A1*28 (colorectal cancer and SCLC) higher risk for toxicity

Pharmacokinetics--

What the bodydoes to the drug

Pharmacodynamics--

What the drugdoes to the body

Regarding CYP2D6, who are the poor metabolizers?

White, black, asian

Antacids consist of

a metallic cation and basic ion calcium carbonate, magnesium hydroxide which neutralize acidity in the stomach by raising the pH don't take within 2 hours of cipro or doxycycline/tetracycline

pediatric cough and cold medications be relabeled as not indicated for use in children under

age 4

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

all of the above

Type B

are allergic responses

Type 1

are anaphylactic and immediate

Type 4

are cell mediated, delayed hypersensitivity

Type 3

are complex immune reactions and are also called serum sickness

Type C

are cumulative effects of a drug from chronic use

Type 2

are cytotoxic and also called an autoimmune response

Type D

are delayed reactions that not apparent initially after the drug is taken, and are teratogens and carcinogens

Type A

are reactions that are predictable

cyclooxygenase inhibitors

aspirin and the NSAIDS ibuprofen and naproxen risk of gastrointestinal bleeding When combined with antiplatelet or anticoagulant medications, the risk is significantly increased and may be life-threatening.

A patient with benign prostatic hypertrophy (BPH) has been prescribed prazosin (Minipress). How do Alpha-1-blocking agents, such as prazosin, assist in treating the symptoms of BPH? A)They increase gastric motility B)They increase skeletal muscle contraction C)They inhibit contraction of the urinary bladder D)They decrease blood pressure

c) They inhibit contraction of the urinary bladder. The utility of alpha adrenergic blockers is based on their ability to inhibit bladder outlet obstruction that is related to alpha-1 adrenergic mediated contraction of prostatic smooth muscle. prazosin is not typically used to treat BPH due to the frequent dosing requirements and risk of cardiovascular side effects. Tamsulosin, alfuzosin, and silodosin have increased selectivity for the alpha-1 receptors in the prostate, and as a result these drugs have little effect on blood pressure while relieving symptoms associated with BPH

The first step in the prescribing process according to The WHO is choosing the treatment educating the patient about the medication diagnosing the patients problem starting the treatment

diagnosing the patients problem

Anticholinergics The primary adverse effects

diphenhydramine such as dry mouth, constipation, blurred vision, tinnitus. Older male patients may have difficulty in urinating. Older patients may develop delirium from modest doses of diphenhydramine.

OTC decongestant medications to manufacture methamphetamine has led to changes in how the drugs are sold in the United States. Methamphetamine precursor chemicals ....

ephedrine, pseudoephedrine, or phenylpropanolamine. stored behind the counter Ask for identification and keep a log of who is purchasing the drugs

Monitoring for a patient taking iron to treat iron deficiency anemia is hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started complete blood count every 4 weeks throughout treatment annual complete blood count reticulocyte count in 4 weeks

hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started

OTC medications that may

impair driving.

A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is: o A cytotoxic hypersensitivity reaction o An immune complex hypersensitivity o An immediate hypersensitivity reaction o A delayed hypersensitivity reaction

o A cytotoxic hypersensitivity reaction type II: the antibodies produced by the immune response bind to antigens on the patient's own cell surfaces

The elderly are at high risk of ADRs due to: o Having greater muscle mass than younger adults, leading to higher volume of distribution o The extensive studies that have been conducted on drug safety in this age group o The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect o Age-related decrease in renal function

o Age-related decrease in renal function

Genetic polymorphisms account for differences in metabolism, including: o Poor metabolizers (PMs) that lack a working enzyme o Intermediate metabolizers (IMs) that have one working, wild-type allele and one mutant allele o Extensive metabolizers (EMs), with two normally functioning alleles o All of the above

o All of the above

Which of the following factors may adversely affect a patient's adherence to a therapeutic drug regimen? o Complexity of the drug regimen o Patient's perception of the potential adverse effects of the drugs o Both A and B o Neither A nor B

o Both A and B

The first step in the prescribing process according to the World Health Organization is: o Choosing the treatment o Educating the patient about the medication o Diagnosing the patient's problem o Starting the treatment

o Diagnosing the patient's problem

A twenty four year old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type ____ ADR when he no longer requires the opioids. o A o C o E o G

o E

The role of the nurse practitioner in the use of herbal medication is to: o Maintain competence in the prescribing of common herbal remedies. o Recommend common OTC herbs to patients. o Educate patients and guide them to appropriate sources of care. o Encourage patients to not use herbal therapy due to the documented dangers.

o Educate patients and guide them to appropriate sources of care.

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: o His appropriately only telling you about his regularly prescribed medications o His hiding information regarding his inappropriate use of aspirin from you o His common misconception that intermittently taking OTC medications are not an important part of his drug history o A common misuse of OTC aspirin

o His common misconception that intermittently taking OTC medications are not an important part of his drug history

The type of ADR that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic dose is: o Type A o Type B o Type C o Type D

o Type A

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs: o With a longer half-life so that missed doses produce a longer taper on the drug curve o In oral formulations that are more easily taken o That do not require frequent monitoring o Combined with patient education about the need to adhere even when symptoms are absent

o With a longer half-life so that missed doses produce a longer taper on the drug curve

A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? body temperature varies between mean and women muscle mass is greater in women percentage of fat differs between genders proven subjective factors exist between the genders

percentage of fat differs between genders

What type of metabolism utilizes oxidation, reducation and hydrolysis reactions?

phase 1 metabolism responsible for 59% of all ADRs?

Dextromethorphan is abused for its ability to

produce hallucinations and a dissociative state, with the peak age for abuse at 15 to 19 years

Ritonavir and grapefruit are what kind of inhibitors with PGP?

suicidal

Pharmacogenomics

the influence of GENETIC variation on drug response in patients by correlating gene expression with a drug's efficacy or toxicity. Specific variations include CYP 450 enzymes, P-Glycoprotein, and phenotypes.

FDA does not regulate herbs so,

there can be a wide variation in the components of the herbs

Mandated redesign of OTC labels:

uniformity of labeling, consistent presentation of information, use of lay language

Cough and cold medications may contain

up to 25% alcohol

Elimination

which is the REMOVAL of the drug from the body by organs of elimination