Quiz Questions

Low-dose aspirin has a half-life of 2 hours. What does this mean?

50% of the drug will be cleared from systemic circulation within 2 hours of drug administration. (Chap 3)

Low dose aspirin is on average 90% bioavailable. What does this mean?

90% of the amount of aspirin administered will reach systemic circulation following administration.

A manufacturer advertises a product as one that contains vitamins, minerals, and amino acids to support physical structure and metabolic function and may be used to supplement nutrient intake from food and beverage. Since the product contains calcium, the manufacturer adds the following health claim to its packaging "adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis." What appears to be the intended use and classification of this product under FDA regulation?

A dietary supplement.

Mr. Barns has been struggling with constipation despite changing his diet, hydration and exercise habits. He has also tried fiber supplements (Metamucil) but no success. Which class of laxatives should be prescribed next to soften the stool by reducing oil-water and incorporating more water and fat into the stool for easier passage?

A surfactant laxative, such as Colace (docusate)

Ms. Susie is a 60 YO female with HF, elevated serum sodium, 2+ pitting edema in her bilateral lower extremities. She also has history of stomach ulceration and mild to moderate osteoarthritis in her hips. Which class of pain medication would be most appropriate and result in the least risk of dependency and abuse to manage her pain?

Acetaminophen.

Depending on the drug, anti-emetic agents may target the production of which neurotransmitters to reduce nausea and vomiting, particularly in patients with post-operative or chemotherapy-induced nausea and vomiting?

Acetylcholine, Dopamine, Histamine, Serotonin

Which of the following drugs has the mechanism of action of bronchodilation for treatment of asthma?

Albuterol (beta-2 adrenergic agonist)

Which of the following individuals may require micronutrient supplementation of one or more nutrients to achieve nutrient adequacy and prevent nutrient deficiency?

All of the above; 2-month old who is exclusively breast fed, a 25YO female who is sexually active, a 45YO male with celiac, a 55YO male following a calorie-restricted diet for weight management, a 75YO female with hx of bone fracture.

Ms. Marsh develops a severe cough and angioedema while taking an ACE inhibitor. Which class of anti-hypertensive medications would not be appropriate for Ms. Marsh given their cross-sensitivity with ACE inhibitors?

Angiotensin II receptor blockers (ARBs)

Mr. Carson is newly diagnosed with GERD. He is looking for immediate relief of his symptoms, that is, immediate suppression of stomach acid, since his doctor told him the prescription medication will take several days to take full effect. Which medication would be most appropriate for Mr. Carson to take for immediate acid suppression?

Antacid such as Tums

Ms. Ruby is taking tamoxifen for treatment of estrogen receptor positive (ER+) breast cancer. Medications in which drug class must be prescribed with caution while Ms. Ruby is taking tamoxifen since some may inhibit CYP2D6, interfering with metabolism and therapeutic efficacy of tamoxifen?

Antidepressants - SSRIs (tamoxifen is metabolized via CYP450 and CYP2D6, SSRIs inhibit this pathway)

Theophylline, a bronchodilator, may be prescribed for the treatment of asthma. Taking this medication in combination with which dietary substance may create a drug-nutrient interaction resulting in enhanced metabolic activity and side effects such as elevated heart rate since both substances raise levels of cyclic AMP?

Caffeine

Ms. Betty Sue was prescribed levofloxacin for the treatment of chronic urinary tract infections. She should be advised to take levofloxacin either two hours before or 4 hours after meals to prevent chelation and potential deficiency of which nutrients?

Calcium, magnesium, iron

Ms. Williams receives a long-term enteral nutrition support via PEG. She is able to swallow some medications by mouth, either whole with water or crushed in applesauce, she is currently prescribed Dabigatran. How should the medication be administered to this patient?

Capsule administer whole with water via mouth. If capsule is opened it will significantly increase bioavailability.

Mr. Marcus is a 35 YO male prescribed an opioid for moderate to severe pain management following MVA. Taking an opioid places him at risk for which nutrition-related adverse effect?

Constipation

Mr. Gerald is a 55 YO male who is experiencing neuropathic pain secondary to poorly controlled T2DM. Which class of pain medication would be most appropriate and result in the least risk of dependency and abuse to manage his pain? Options: Acetaminophen, Aspirin, Oxycodone, Any of the Above, None of the Above.

Correct answer: None of the above.

Ms. Parker is a patient in the step-down ICU. She is receiving round-the-clock enteral feeding through a PEG tube. Why would this patient be prescribed an IV opioid such as IV oxycodone, rather than a sustained release (SR) oxycodone that is crushed and flushed through the PEG?

Crushing SR oxycodone will increase the dose of oxycodone, resulting in higher peak plasma concentration and risk of adverse effects such as respiratory depression.

Ms. Zelma was recently diagnosed with bipolar disorder. Her physician plans to prescribe an anti-psychotic drug. Which metabolic health conditions that Ms. Zelma either has or might be at risk for developing must the physician consider when selecting an anti-psychotic drug?

Diabetes, dyslipidemia, weight gain

Ms. Waters is prescribed trastuzumab for treatment of HER2 overexpression metastatic breast cancer. She is interested in taking Echinacea to support a healthy immune system during treatment and asks if this would be appropriate. What recommendation should be provided

Dietary supplements may interfere with the effectiveness of chemotherapeutic agents and should not be taken during active treatment

Mr. Merchant is 5' 8" and weighs 210 pounds. He is receiving doxorubicin for treatment of bladder cancer. Per current clinical practice guidelines, how should doxorubicin be dosed for this patient?

Dosing should be based on actual body weight

Anti-depressant medications may be prescribed for treatment/management of conditions beyond depression. Which of the following are two examples of when an anti-depressant might be used for a non-depression condition?

Emesis and neuropathic pain

Which antibiotic doubles as a prokinetic motility agent to induce upper gastrointestinal motility and may be used for treating gastroparesis in patients with DM?

Erythromycin

T/F: To achieve complete pain relief, the right combination, dosage, and method of administration of analgesics must be prescribed.

False, because "pain-free" is unrealistic, patient should expect pain management.

Based on the scientific evidence, who is the primary source of non-medical use prescription pain relievers contributing to the opioid epidemic?

Friends or relatives

Ms. Flower is prescribed paclitaxel for treatment of cancer. She develops myelosuppression as a toxicity-related side effect of the chemotherapeutic agent. What nutrition intervention is appropriate for this patient?

Fully cooked plant or animal-based diet

Ms. Smith is a 72 yo patient with stage 3 CKD. Her physician prescribes a new medication that is metabolized and cleared via the kidneys (renal clearance). The physician is aware that renal clearance of the medication is a concern given Ms. Smiths age and impaired renal function. Which lab value should the physician review when dosing the new medication to reduce the risk of drug toxicity?

GFR

Mr. Gray takes phenytoin to manage a seizure disorder. Which nutrition-focused physical findings might indicate phenytoin toxicity?

Gingival hyperplasia, rash, nystagmus

Mr. Jones is prescribed an alpha-glucosidase inhibitor to manage his T2DM. One morning after waking and taking his medication before breakfast, he experiences hypoglycemia as evidenced by fasting blood glucose 60 mL/dL and light headedness. What would be the most appropriate intervention to treat this?

Have Mr. Jones drink ¼ cup of OJ

Mr. Tipmore is taking metoprolol, a b-blocker, to help manage his CHF. He recently reported that he's experiencing some significant side effects from the medication, so his doctor wants to discontinue the use of this medication. What process should be taken to safety transition Mr. Tipmore to a new medication?

He should be slowly transitioned off the beta blocker and on to a new medication.

Ms. Roberts has atrial fibrillation. She is taking warfarin to prevent stroke. She follows a vegan diet and loves green leafy vegetables. She has a history of UTIs and drinks cranberry juice every morning. However, she recently developed a UTI so she is prescribed Bactrim for 10 days. Which aspect of Ms. Roberts health and nutrition history should be most concerning to you related to a potential interaction with concurrent warfarin use?

Her antibiotic use to treat her UTI.

Which route of administration would result in the shortest Tmax?

Intravenous (IV)

Mr. Michaels has chronic GERD and has been taking lansoprazole, a PPI, daily for the last 2 years. He reports fatigue, pallor, decrease in appetite, tingling in his hands and feet, loss of balance. He may be at risk for what deficiency of nutrients secondary to long-term use of the PPI?

Iron and Vitamin B12

A patient brings the RDN a multivitamin-mineral bottle with the claim "high potency multivitamin, multi-mineral dietary supplement tablets" and asks the RDN what this means. What's the response?

It means the product contains 100% or more of the Reference Daily Intakes for at least two-thirds of the vitamins and minerals with RDI in the product.

A patient brings the RDN a B-complex vitamin bottle that contains the USP seal and asks the RDN what this means. What's the response?

It means the product has been tested for positive identification, purity, potency, and performance by an independent agency.

Ms. Betty has severe obesity as evidenced by a BMI of 42 and wasit circumference of 44 inches. Which hypoglycemic medication may be most appropriate for her primary care prescriber to consider to manage both her blood glucose secondary to T2DM and promote weight loss secondary to obesity

Liraglutide (Victoza)

Mr. Walters is a 70 year old patient with heart failure. He has a history of hyperkalemia and gout. Which type of diuretic would be most appropriate for treating his condition?

Loop. There are no contraindications with gout. Potassium sparing is wrong because it decreases urinary secretion which increases the risk for hyperkalemia. Thiazide can worsen gout so that is also wrong.

Which class of chemotherapeutic agents targets specific antigens on the surface of tumor cells to stimulate the body's nature immune response for triggering cell death?

Monoclonal Antibodies

Ms. Leeson daily medication regimen includes a statin for her CVD, metformin for her T2DM, NSAID for her osteoarthritis and Lisinopril for her HTN. She is diagnosed with peptic ulcer disease. Which of her daily medications should be discontinued or changed to one that will not diminish PGE2 and support maintenance of health, intact gut mucosa and decreased gastric acid production for ulcer healing and prevention of future ulcer formation?

NSAID

Mrs. Jones has T2DM. You are concerned that despite her self-reported adherence to the prescribed diet, exercise, and lifestyle plan discussed that her blood glucose readings remain elevated especially in the evening. You wonder if she may require an adjustment to her oral diabetic medication. You consider how the concentration of the medication (taken in the morning), changes over time in the body as it is absorbed, distributed, metabolized and eliminated. You are using which principle of pharmacology in your clinical decision-making?

Pharmacokinetics

GI upset and diarrhea are common side effects of a variety of antibiotics. Patients may continue to experience these side effects even after they have ended their antibiotic therapy. These continued effects of the antibiotics in continuing to suppress bacterial growth reflect which pharmacodynamics property of antibiotics?

Post Antibiotic Effect

Which of the following is the ideal composition of hormone contraception to reduce risk of endometrial and breast cancer, cardiovascular outcomes and depression?

Progesterone and Estrogen combination

Your patient is prescribed a rifamycin antibiotic for the treatment of a prosthetic heart valve device infection. Upon nutrition focused physical exam, you notice an orange-red discoloration to the patient's body fluids including tears and saliva. What is most likely causing this discoloration?

Rifamycin

Mr. Bert is a 72 yo male diagnosed with T2DM. He has age-appropriate kidnet function. Which class of oral hypoglycemic drugs would be least appropriate for him to be prescribed as a first-line therapy due to potential side effects of UTI, dehydration, hypotension, and acute kidney injury?

SGLT2 inhibitors

Long term use of prednisone, particularly at more than 7.5 mg daily for more than 3 weeks, could lead to what health condition?

Secondary adrenal insufficiency

Mrs. Watson has hypertension and is currently taking Lisinopril. What nutrition recommendation should the RDN provide to Mrs. Watson to reduce her risk of a drug-nutrient interaction?

She needs to moderate her intake of potassium-containing foods, including potassium-containing salt substitutes, as she could develop hyperkalemia while taking this drug.

Ms. Patrick is taking lithium for treatment of bipolar depression. Her blood pressure is well-controlled and classified as normal. Which dietary recommendation should the RDN provide to this patient?

She should be consistent in her sodium intake at no more than 2300 mg/day

Ms. Watson is taking Guaifenesin, an expectorant, to help clear secretions from the trachea and bronchi. What nutrition intervention would you recommend for this patient?

She should consume at minimum 64 fl oz of water per day.

Mrs. Green, a 48 YO female, demonstrates risk for osteoporotic bone fractures based on her BMD per DXA scan. She has severe lactose intolerance, so consumption of dairy products is not a good option to support calcium intake. Her serum 25(OH) vitamin D is WNL. What recommendation would be most appropriate to give Mrs. Green regarding use of dietary calcium and vitamin D supplements to reduce bone loss and fracture risk?

She should consume up to two divided doses of 500 mg elemental calcium + 800 IU vitamin D per day.

Ms. Jennings is taking methotrexate as a chemotherapeutic agent for treatment of cancer. She does not demonstrate any toxicity side effects from methotrexate. What nutrition intervention should Ms. Jennings follow?

She should eat a balanced diet containing folate/folic acid but not supplement folic acid.

Mrs. Bacon is a post-menopausal female with low bone mass who demonstrates multiple risk factors for bone fx and is prescribed Fosamax, a bisphosphonate, by her primary care provider. What guideline should she follow when taking Fosamax orally to reduce risk of esophageal ulceration?

She should remain upright for at least 30 minutes after taking the drug.

Ms. Susie has GERD and has been prescribed omeprazole, a PPI, by her primary care doctor. Ideally how should this medication be taken in relationship to food in order to be most effective therapeutically?

She should take it 30 minutes before a meal.

your patient Ms. Spring has hypothyroidism and takes Synthroid (levothyroxine). Which recommendation should she follow to support drug absorption?

She should take the medication in the morning on an empty stomach.

Ms. Mary Lou is prescribed Evista, a SERM, for managing her osteoporosis. She also has hypothyroidism and takes Synthroid. How should she take these medications to support their respective therapeutic effects?

She should take them separately, separating them by 12 hours.

Mr. Johnson cardiologist has recommended statin therapy if he is unable to improve his lipid profile through diet and exercise. He is concerned about potential side effects with statin use, mainly related to development of myalgia and myopathy. Which of the following aspects should be considered when the statin is prescribed to reduce Mr. Johnsons risk of these side effects associated with statins?

Start with the lowest, highest potency dose of a non-lipophilic statin, such as 5 mg rosuvastatin.

Ms. June has migraines and depression. She takes a serotonin receptor agonist to reduce migraine occurrence. She takes St. Johns wort, a dietary supplement, to manage her depression. St. Johns wort inhibits serotonin reuptake. What effect will taking both medication and dietary supplement at the same time have on serotonin receptor activity in the body?

Taking both together will increase serotonin activity at the receptor sites. Why? Agnosts activate the receptor. She is taking a serotonin receptor agonist, so serotonin activity will increase. In addition she is taking St. Johns wort which prevents serotonin clearance by the body causing more serotonin to be present for activity at receptor sites. (Ch 2).

Ms. Winter has hypothyroidism and take Synthroid (levothyroxine). She was recently started on enteral nutrition support secondary to status post bowel resection. What modification should be made to the administration of her Synthroid and/or enteral tube feed?

The levothyroxine dosage should be increased, but tube feedings do not need to be discontinued/held.

Mr. Russel has end stage liver disease. He takes multiple oral medications to manage the complications of ESLD. One of his medications, PPI, prescribed to reduce gastric acid secretion of gastric parietal cells, appears to be causing adverse effects. Rather than changing the medication, the physician adjusts the dosage. Why would the physician perform this action?

The liver disease is affecting the metabolism of the medication.

Mr. Levine is taking Nardil (phenelzine) a MAOI for treatment of depression. Which dietary recommendation should the RDN provide to this patient?

The patient should decrease his consumption of aged cheese (parmesan), cured meats (salami), fermented foods (sauerkraut and soy sauce) and tap beer

A 40YO pre-menopausal patient recently treated with a pharmaceutical grade iron supplement for iron deficiency anemia was told by her physician that she should switch to a daily maintenance dose of iron by purchasing an over-the-counter iron supplement product providing 18mg of elemental iron/day. She asks the RDN for guidance on which product to select. What should be the RDN's response?

The patient should select an iron supplement that contains product name (statement of identity), net quality, dietary supplement label including form of iron, and amount of iron per dose, ingredient list, name and address of manufacturer.

Which of the following statements is true regarding dietary supplements?

They may be used by individuals across the life span to meet nutrient requirements or to treat diagnosed nutrient deficiency when used in combination with dietary intake.

Ms. Gerber has elevated triglycerides. She wishes to try a complementary and integrative nutrition approach to lower her levels before using medication. Which therapy would align with evidence-based practice guidelines for reducing triglycerides?

Try taking 4 g omega-3 fatty acids daily.

Mr. Parrott has developed Clostridum difficile (C. diff) infection. Which antibiotic, administered orally, is currently recommended as a first-line therapy for treatment?

Vancomycin

Ms. Susan has T2DM, she has been taking 1000 mg Metformin for 2 years. She begins to experience symptoms of weakness, pain and tingling in her hands and feet, indicating neuropathy. Ms. Susan may be experiencing which nutrient deficiency related to Metformin therapy?

Vitamin B12

which of the following is an example of a label claim that a dietary supplement company would be permitted by law to place on a bottle of vitamin D tablets?

Vitamin D supports healthy bones and teeth.

Mr. James is 22 YO male who has the flu. Normally he is healthy - no chronic conditions. He reports that he is taking 2 capsules of extra strength Tylenol (500 mg acetaminophen per caplet) every 6 hours for his fever, aches and pains. He is also taking 2 capsules of Alka-Seltzer plus (325 mg acetaminophen per capsule) every 4 hours for his congestion. Are there any changes Mr. James should make to this regimen?

Yes, he needs to reduce the dosing and/or frequency of one or both medications so that he doesn't exceed 4000 mg acetaminophen per day.

Ms. Marigold was recently diagnosed with depression. Part of her depression is caused by her obesity (BMI 55). She recently enrolled in a high intensity lifestyle intervention program for weight management as she identified that her weight status has to do with her poor diet, exercise and lifestyle choices over the past 10 years. Which medication could her physician prescribe to treat both her depression and support her weight loss goals?

bupropion (Wellbutrin)

As a whole, patients prescribed diuretics are at risk for what biochemical abnormality that should be assessed, monitored and evaluated by the RDN when performing the NCP and providing medical nutrition therapy?

electrolytes

Mr. Rogers is prescribed cisplatin, a platinum analogue, for treatment of esophageal cancer. He develops mucocytis and oral thrush. Which intervention is appropriate for this patient?

oral decontamination with room temperature anti-fungal rinse

Mr. Stephens was diagnosed with dyslipidemia as evidenced by elevated LDL-C, decreased HDL and elevated triglycerides. He does not have familial hypercholesterolemia. He is on a fixed income. A medication from which drug class should be prescribed first to treat his high LDL and reduce risk of cardiovascular outcomes?

statin

Remmie is a 10 YO boy with a seizure disorder. His BMI-for-age percentile is 15th%. The RDN and physician would like to see him gain some weight to be closer to the 25th%. Which medication could his physician prescribe to treat both the seizure disorder and support weight management goals?

valproate (Depakote) it increases appetite