Week 1 Quiz
A pregnant patient asks her provider about the safe use of medications during the third trimester. What will the provider tell her about drugs taken at this stage? a) "They may need to be given in higher doses if they undergo renal clearance." b) "They require lower doses if they are metabolized by the liver." c) "They are less likely to cross the placenta and affect the fetus." d) "Drugs are more likely to cause anatomical defects if they are taken during the second trimester.
a) "They may need to be given in higher doses if they undergo renal clearance." In the third trimester, drugs excreted by the kidneys may have to be increased, because renal blood flow is doubled, the glomerular filtration rate is increased, and drug clearance is accelerated. Hepatic metabolism increases; therefore, drugs metabolized by the liver may need to be increased. Drugs are not less likely to cross the placenta. Anatomic defects are more likely to occur in the embryonic period, which is in weeks 3 through 8 in the first trimester.
A provider is concerned about renal function in an 84-year-old patient who is taking several medications. What laboratory result will the provider order? a) Creatinine clearance b) Sodium levels c) Potassium levels d) Serum creatinine
a) Creatinine clearance The proper index of renal function in older adults is creatinine clearance, which indicates renal function in older patients whose organs are undergoing age-related deterioration. Sodium and potassium levels are not indicative of renal function. Serum creatinine levels do not accurately reflect kidney function in older adults because lean muscle mass, which is the source of creatinine in serum, declines and may be low even with reduced kidney function.
1. The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which action is most important when prescribing this medication to an 80-year-old patient? a) Obtaining baseline liver function studies b) Ensuring that the drug is taken in the correct dose at the correct time c) Discontinuing the order; the drug is contraindicated for this patient d) Giving the medication intravenously to avoid first pass metabolism
a) Obtaining baseline liver function studies The drug manual indicates that this drug increases risk of hepatotoxicity for elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with posttreatment data to determine whether the drug is affecting the liver. Taking the correct dose at the correct interval may minimize risk, but without baseline information, the effects cannot be determined. Drugs are not routinely contraindicated for an increased risk of adverse effects.
Which patient statement suggests to the provider that the patient's nonadherence with their medication plan is related to dissatisfaction with the therapy? a) This medication is too expensive; I can't afford it any longer." b) "I've been taking this medication for well over a week and I lost only a half a pound." c) "It's too hard to remember to take the pill every other day; so, I've missed several doses." d) "I have a very intense, fast paced job; it's hard to make time to take the medication like I should."
b) "I've been taking this medication for well over a week and I lost only a half a pound." Dissatisfaction with drug therapy can take the form of a patient's unrealistic expectation of desired results such as in the case of significant weight loss in a relatively short period of time. Medication costs, forgetfulness, and lack of planning are suggested by the other options.
A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time period? a) Immediately before conception b) During the first trimester c) During the second trimester d) During the third trimester
b) During the first trimester Gross malformations are caused by exposure to teratogens during the embryonic period, which is considered the first trimester. This is the time when the basic shape of internal organs and other structures is established. No risk exists immediately before conception. Teratogen exposure during the second and third trimesters usually disrupts function rather than gross anatomy.
When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity? a) Avoid exercise for 2 hours after administration. b) Substitute grapefruit juice with orange juice. c) Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT). d) Take the medication with an NSAID or other anti-inflammatory drug.
b) Substitute grapefruit juice with orange juice. Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin. The juice raises drug levels decreasing the intestinal metabolism of the drug resulting in increased drug levels which increases the risk for adverse effects such as muscle toxicity. Taking the drug with an anti-inflammatory drug and avoiding exercise after administration are not supported by science. Monitoring AST and ALT detects liver toxicity, not muscle toxicity.
The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain. What instruction will the prescriber include regarding alcohol intake? a) "If you plan to drink alcohol, I will write an order for acetaminophen without hydrocodone for your pain." b) "I'd suggest that you substitute ibuprofen for pain on days when you plan to drink alcohol." c) "You should avoid drinking alcohol while you are taking the pain medication I've ordered." d) "You should limit your alcohol intake to no more than two servings of alcohol daily while on the pain medication."
c) "You should avoid drinking alcohol while you are taking the pain medication I've ordered." Combining a hepatotoxic drug with other hepatotoxic agents increases the risk of hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol; even two drinks with acetaminophen can produce this effect. Hydrocodone does not contribute to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the pain is mild. Limiting alcohol intake to two servings per day still increases the risk of hepatotoxicity.
A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement informs the prescriber's response when explaining this phenomenon to the patient? a) Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b) Because the drug preparations are chemically equivalent, the actions of the two brands must be identical. c) Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action. d) The bioavailability of a drug is determined by the amount of the drug in each dose.
c) Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action. Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug.
A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate? a) Increase dosage of the CYP3A4 inducer. b) Decrease dosage of the CYP3A4 inducer. c) Increase dosage of the CYP3A4 substrate. d) Decrease dosage of the CYP3A4 substrate.
c) Increase dosage of the CYP3A4 substrate. A drug that acts as an inducing agent for an enzyme system increases the metabolism of drugs metabolized by that enzyme system, thereby lowering the level of those drugs in the body and requiring higher doses to maintain drug effectiveness. Although decreasing the dosage of the drug that induces metabolism may seem reasonable at first glance, this may decrease the therapeutic level of the drug making it ineffective in treating the condition for which it was prescribed.
Which prescriber action will have the greatest impact on the patient's commitment to adherence to any type of medication therapy? a) Prescribing the medication in oral form whenever possible b) Scheduling once a day administration c) Providing medication education that the patient can easily understand d) Assuring that the medication prescription will be covered by the patient's insurance
c) Providing medication education that the patient can easily understand No other provider action assures the patient's commitment to adhere to a medication plan more than effective medication education provided in a concise, understandable form. It is not always possible or appropriate to prescribe an oral form. While medication costs can present a barrier to compliance, insurance coverage is but one factor affecting costs.
A patient with bipolar disorder is prescribed daily lithium. Which action is most important for the provider to take in order to determine if the therapeutic level is maintained? a) Evaluate pre-administration blood work. b) Prescribe the lithium to be taken at regular intervals. c) Order periodic laboratory testing. d) Assess the patient for signs and symptoms of lithium toxicity.
c) order periodic laboratory testing Therapeutic serum levels are determined through periodic laboratory testing. Preadministration blood work may be necessary to obtain baseline status prior to initiating treatment, but it will not determine therapeutic levels. Scheduling medication administration at regular intervals will help to ensure medication is absorbed and metabolized predictably, but it will not determine therapeutic blood levels. Assessing the patient for signs and symptoms of toxicity will help to determine if the therapeutic level has been exceeded, not maintained.
