Chamberlain College of Nursing NURSING PHARMACOLOGY NUR6005 Questions And Answers Latest E, Exams of Nursing

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Chamberlain College of Nursing NURSING PHARMACOLOGY

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Chapter 1. The Role of the Nurse Practitioner

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Nurse practitioner prescriptive authority is regulated by:
   1. The National Council of State Boards of Nursing
   2. The U.S. Drug Enforcement Administration
   3. The State Board of Nursing for each state
   4. The State Board of Pharmacy
2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: both in ion tant
3. Clinical judgment in prescribing includes:
   1. Factoring in the cost to the patient of the medication prescribed
   2. Always prescribing the newest medication available for the disease process
   3. (^) Handing out drug samples to poor patients
   4. Prescribing all generic medications to cut costs
4. Criteria for choosing an effective drug for a disorder include:
   1. (^) Asking the patient what drug they think would work best for them
   2. Consulting nationally recognized guidelines for disease management
   3. Prescribing medications that are available as samples before writing a prescription
   4. Following U.S. Drug Enforcement Administration guidelines for prescribing
5. Nurse practitioner practice may thrive under health-care reform because of:
   1. Nurses know more about Pharmacology than other prescribers because they take it their basic nursing program and in their APRN program.
   2. Nurses^ care^ for^ the^ patient from^ a^ holistic^ approach^ and^ include the^ patient in decis making regarding their care.
   3. APRNs are less likely to prescribe narcotics and other controlled substances.
   4. APRNs are able to prescribe independently in all states, whereas a physician’s assis needs to have a physician supervising their practice.
   5. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes
   6. The fact that nurse practitioners will be able to practice independently
   7. The fact that nurse practitioners will have full reimbursement under health-care refo

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Chapter 2. Review of Basic Principles of Pharmacology

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because:

2. Distribution of drugs to target tissue may be affected.

3. The solubility of the drug will not match the site of absorption.

4. There will be less free drug available to generate an effect.

5. Drugs bound to albumin are readily excreted by the kidneys.

6. Drugs that have a significant first-pass effect:

7. Must be given by the enteral (oral) route only

8. Bypass the hepatic circulation

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

10. Are converted by the liver to more active and fat-soluble forms

11. The route of excretion of a volatile drug will likely be the:

12. Kidneys

13. Lungs

14. Bile and feces

15. Skin

16. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs:

17. Assure that the drug will reach its intended target tissue

18. Are the reason for giving loading doses

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

20. Are most common in collagen tissues

21. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:

22. Propensity to go to the target receptor

23. Biological half-life

24. Pharmacodynamics

25. Safety and side effects

26. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the

prescription. This is considered a loading dose. A loading dose:

1. Rapidly achieves drug levels in the therapeutic range
2. Requires four- to five-half-lives to attain
3. Is influenced by renal function
4. Is directly related to the drug circulating to the target tissues
5. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:
6. Minimum adverse effect level
7. Peak of action
8. Onset of action
9. Therapeutic range
10. Phenytoin requires that a trough level be drawn. Peak and trough levels are done:
11. When the drug has a wide therapeutic range
12. When the drug will be administered for a short time only
13. When there is a high correlation between the dose and saturation of receptor sites
14. To determine if a drug is in the therapeutic range
15. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:
16. Concentration will produce therapeutic effects
17. Concentration will produce an adverse response
18. Time between doses must be shortened
19. Duration of action of the drug is too long
20. Drugs that are receptor agonists may demonstrate what property?
21. Irreversible binding to the drug receptor site
22. Upregulation with chronic use
23. Desensitization or downregulation with continuous use
24. Inverse relationship between drug concentration and drug action
25. Drugs that are receptor antagonists, such as beta blockers, may cause:
26. Downregulation of the drug receptor
27. An exaggerated response if abruptly discontinued
28. Partial blockade of the effects of agonist drugs
29. An exaggerated response to competitive drug agonists
30. Factors that affect gastric drug absorption include:

1. Liver enzyme activity
2. Protein-binding properties of the drug molecule
3. Lipid solubility of the drug
4. Ability to chew and swallow
5. Drugs administered via IV:
6. Need to be lipid soluble in order to be easily absorbed
7. Begin distribution into the body immediately
8. Are easily absorbed if they are nonionized
9. May use pinocytosis to be absorbed
10. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
11. The sum of the effects of each drug individually
12. Greater than the sum of the effects of each drug individually
13. Less than the effect of each drug individually
14. Not predictable, as it varies with each individual
15. Which of the following statements about bioavailability is true? es or drugs
16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?
17. Water soluble and ionized drugs cross these barriers rapidly.
18. (^) The blood-brain barrier slows the entry of many drugs into and from brain cells.
19. The fetal-placental barrier protects the fetus from drugs taken by the mother.
20. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.
21. 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:
22. Inactivate prodrugs before they can be activated by target tissues
23. Change the drugs so they can cross plasma membranes
24. Change drug molecules to a form that an excretory organ can excrete
25. Bioavailability issues are especially important for drugs with narrow therapeutic rang sustained-release mechanisms.
26. All brands of a drug have the same bioavailability.
27. Drugs that are administered more than once a day have greater bioavailability than given once daily.
28. Combining an active drug with an inert substance does not affect bioavailability.

4. Make these drugs more ionized and polar to facilitate excretion
5. Once they have been metabolized by the liver, the metabolites may be:
6. More active than the parent drug
7. Less active than the parent drug
8. Totally “deactivated” so they are excreted without any effect 4. All of the above
9. 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:
10. Reduced circulation and perfusion of the kidney
11. Chronic renal disease
12. Competition for a transport site by another drug
13. Unbinding a nonvolatile drug from plasma proteins
14. Steady state is:
15. The point on the drug concentration curve when absorption exceeds excretion
16. When the amount of drug in the body remains constant
17. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above
18. Two different pain medications are given together for pain relief. The drug—drug interaction is:
19. Synergistic
20. Antagonistic
21. Potentiative
22. Additive
23. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
24. Reducing the dosage of one of the drugs
25. Scheduling their administration at different times
26. Prescribing a third drug to counteract the adverse reaction of the combination
27. Reducing the dosage of both drugs
28. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
29. Protein malnutrition
30. Iron-deficiency anemia 3. Both 1 and 2

4. Neither 1 nor 2

24. The time required for the amount of drug in the body to decrease by 50% is called:
25. Steady state
26. Half-life
27. Phase II metabolism
28. Reduced bioavailability time
29. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:
30. Upregulate the total number of receptors
31. Block the receptor with a partial agonist
32. Alter the drug’s metabolism
33. Downregulate the numbers of that specific receptor
34. Drug antagonism is best defined as an effect of a drug that:
35. Leads to major physiological and psychological dependence
36. Is modified by the concurrent administration of another drug
37. Cannot be metabolized before another dose is administered
38. Leads to a decreased physiological response when combined with another drug
39. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?
40. “Avoid any other oral medicines while taking this drug.”
41. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
42. “The tablet may be crushed if you have any difficulty taking it.”
43. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”
44. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in:
45. Disintegration
46. Toxicity
47. Malabsorption
48. Deterioration
49. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?
50. Sodium bicarbonate
51. Ascorbic acid

3. Salicylic acid
4. Glucose
5. Which of the following variables is a factor in drug absorption?
6. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
7. A rich blood supply to the area of absorption leads to better absorption.
8. The less soluble the drug, the more easily it is absorbed.
9. Ionized drugs are easily absorbed across the cell membrane.
10. An advantage of prescribing a sublingual medication is that the medication is:
11. Absorbed rapidly
12. Excreted rapidly
13. Metabolized minimally
14. Distributed equally
15. Drugs that use CYP 3A4 isoenzymes for metabolism may:
16. Induce the metabolism of another drug
17. Inhibit the metabolism of another drug 3. Both 1 and 2 4. Neither 1 nor 2
18. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
19. After the second dose
20. After four to five half-lives
21. When the patient feels the full effect of the drug
22. One hour after IV administration
23. Upregulation or hypersensitization may lead to:
24. Increased response to a drug
25. Decreased response to a drug
26. An exaggerated response if the drug is withdrawn
27. Refractoriness or complete lack of response

Chapter 5. Adverse Drug Reactions

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):
   1. A 32-year-old male
   2. A 22-year-old female
   3. A 3-month-old female
   4. A 48-year-old male
2. Infants and young children are at higher risk of ADRs due to: ation of
3. The elderly are at high risk of ADRs due to: bution rapeutic
4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type:
   1. A
   2. B
   3. C
   4. D
5. Digoxin may cause a type A adverse drug reaction due to:
   1. Idiosyncratic effects
   2. Its narrow therapeutic index
   3. Being a teratogen
   4. Being a carcinogen
6. Sarah developed a rash after using a topical medication. This is a type allergic drug reaction.
   1. I
   2. II
   3. III
7. Immature renal function in school-age children
8. Lack of safety and efficacy studies in the pediatric population
9. Children’s skin being thicker than adults, requiring higher dosages of topical medic
10. Infant boys having a higher proportion of muscle mass, leading to a higher volume distribution
11. Having greater muscle mass than younger adults, leading to higher volume of distri
12. The extensive studies that have been conducted on drug safety in this age group
13. The blood-brain barrier being less permeable, requiring higher doses to achieve the effect
14. Age-related decrease in renal function

4. IV

7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n):
   1. Cytotoxic hypersensitivity reaction
   2. Immune complex hypersensitivity
   3. Immediate hypersensitivity reaction
   4. Delayed hypersensitivity reaction
8. 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
9. James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction?
   1. Type B
   2. Type C
   3. Type E
   4. Type F
10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known:
    1. Teratogens
    2. Carcinogens
    3. To cause hypersensitivity reactions
    4. Hypothalamus-pituitary-adrenal axis suppressants
11. A 24-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 a adverse drug reaction when he no longer requires the opioids.
    1. Rapid
    2. First-dose
    3. Late
    4. Delayed
12. An example of a first-dose reaction that may occur includes:
13. Orthostatic hypotension that does not occur with repeated doses

2. Purple glove syndrome with phenytoin use
3. Hemolytic anemia from ceftriaxone use
4. Contact dermatitis from neomycin use
5. Drugs that are prone to cause adverse drug effects include:
6. Diuretics
7. Inhaled anticholinergics
8. Insulins
9. Stimulants
10. The U.S. Food and Drug Administration MedWatch system is activated when:
11. There is an adverse event to a vaccine.
12. The patient has a severe reaction that is noted in the “Severe Reaction” section in the medication label.
13. A lactating woman takes a medication that is potentially toxic to the breastfeeding i
14. An^ adverse event or^ serious^ problem^ occurs^ with^ a^ medication^ that^ is^ not^ already ide on the label.
15. The Vaccine Adverse Events Reporting System is: nfant. ntified adverse port

Chapter 6. Factors That Foster Positive Outcome

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. 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?
2. Financial status
3. Mobility
4. Social support
5. Sexual practices
6. Elena Vasquez’s 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?
7. A mandatory reporting system for all health-care providers when they encounter an vaccine event
8. A^ voluntary^ reporting^ system^ that^ health-care^ providers or consumers may^ use^ to re vaccine adverse events
9. Utilized to send out safety alerts regarding emerging vaccine safety issues
10. Activated when a vaccine has been proven to cause significant adverse effects

er.

3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?
4. Stand facing him and speak slowly and clearly.
5. Speak in low tones or find a provider who has a lower voice.
6. Write down the instructions as well as speaking them.
7. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds.
8. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?
   1. Complexity of the drug regimen
   2. Patient perception of the potential adverse effects of the drugs 3. Both 1 and 2
   3. Neither 1 nor 2
9. 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?
10. Increasing copayments for care
11. Unrestricted formularies for drugs, including brand names
12. Increasing the number of people who have access to care
13. Treating a wider range of disorders
14. 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 suggest that he might not be adherent?
15. Ralph states that he always takes the drug “when I feel my pressure is going up.”
16. Ralph contacts his NP to discuss the need to increase the dosage.
17. Ralph consistently keeps his follow-up appointments to check his blood pressure.
18. All of the above show that he is adherent to the drug regimen.
19. 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: ses to
20. Use correct medical terminology because Spanish has a Latin base.
21. Use a family member who speaks more English to act as an interpreter.
22. Use a professional interpreter or a reliable staff member who can act as an interpret
23. Use careful, detailed explanations.
24. Has a short half-life so that missing one dose has limited effect
25. Requires several dosage titrations so that missed doses can be replaced with lower do keep costs down

ating,”

8. 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
9. 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
10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs: absent
11. 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? imes-per- tic of the
12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
13. Older adults and those on fixed incomes
14. Patients with chronic illnesses
15. Patients with copayments for drugs on their insurance
16. Has a tolerability profile with fewer of the adverse effects that are considered “irrit such as nausea and dizziness
17. Must be taken no more than twice a day
18. (^) With a longer half-life so that missed doses produce a longer taper on the drug curve
19. In oral formulations that are more easily taken
20. That do not require frequent monitoring
21. (^) Combined with patient education about the need to adhere even when symptoms are
22. Have the patient purchase a pill container with compartments for daily or multiple t day dosing.
23. Match the clinic appointment to the next time the drug is to be refilled.
24. Write prescriptions for new drugs with shorter times between refills.
25. Give^ the patient^ a^ clear^ drug^ schedule^ that^ the^ provider^ devises^ to fit^ the characteris drug.

4. Patients on public assistance
5. 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:
6. Are well-educated and affluent
7. Have chronic conditions
8. Self-monitor drug effects on their symptoms 4. None of the above guarantee adherence
9. Monitoring adherence can take several forms, including:
10. Patient reports from data in a drug diary
11. Pill counts
12. Laboratory reports and other diagnostic markers 4. All of the above
13. Factors that explain and predict medication adherence include:
14. Social
15. Financial
16. Health system 4. All of the above

Chapter 7. Cultural and Ethnic Influences in Pharmacotherapeutics

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Cultural factors that must be taken into account when prescribing include(s):
   1. Who the decision maker is in the family regarding health-care decisions
   2. The patient’s view of health and illness
   3. Attitudes regarding the use of drugs to treat illness 4. All of the above
2. Ethnic differences have been found in drug:
   1. Absorption
   2. Hepatic metabolism
   3. Filtration at the glomerulus
   4. Passive tubular reabsorption

3. The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:
4. Hospitals
5. Clinics that serve the poor
6. Organizations that receive federal funds
7. Clinics that serve ethnic minorities
8. According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:
9. May be a bilingual family member
10. May be a bilingual nurse or other health-care provider
11. Must be a professionally trained medical interpreter
12. Must be an employee of the organization
13. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
14. The belief among African Americans that prayer is more powerful than drugs
15. Poor compliance on the part of the African American patient
16. The genetic predisposition for illness found among African Americans
17. Discrimination, cultural barriers, and lack of access to health care
18. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
    1. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
    2. Largely unknown due to lack of studies of this population
    3. Rapid metabolism of alcohol, leading to increased tolerance
    4. Decreased elimination of opioids, leading to increased risk for addiction
19. Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
    1. True
    2. False
20. Alterations in drug metabolism among Asians may lead to:
    1. Slower metabolism of antidepressants, requiring lower doses
    2. Faster metabolism of neuroleptics, requiring higher doses
    3. Altered metabolism of omeprazole, requiring higher doses
    4. Slower metabolism of alcohol, requiring higher doses
21. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:

1. Require acetylization in order to metabolize drugs
2. Are unable to tolerate higher doses of some drugs that require acetylization
3. May have a toxic reaction to drugs that require acetylization
4. Require higher doses of drugs metabolized by acetylization to achieve efficacy
5. Hispanic native healers ( curanderas ):
6. Are not heavily utilized by Hispanics who immigrate to the United States
7. Use herbs and teas in their treatment of illness
8. Provide unsafe advice to Hispanics and should not be trusted
9. Need to be licensed in their home country in order to practice in the United States

Chapter 10. Herbal Therapy and Nutritional Supplements

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A good history of herb and supplement use is critical before prescribing because approximately % of patients in the United States are using herbal products.
2. 10
3. 5
4. 38
5. 70
6. A potential harmful effect on patients who take some herbal medication is:
   1. Constipation
   2. Lead poisoning
   3. Diarrhea
   4. Life-threatening rash
7. A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:
   1. Coumadin, which may lead to bleeding problems
   2. Coumarin,^ which^ can^ cause^ liver^ and^ kidney^ damage
   3. Cinnamic aldehyde, which is toxic to the kidney
   4. Cinnamate eugenol, which is toxic to the liver
8. 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:

1. Herbs which are yang in nature
2. Herbs that are yin in nature
3. Ginger
4. Golden seal
5. 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:
6. Get worse
7. Get better
8. Not be adequately treated
9. Need additional herbs to treat the yang
10. In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s:
11. Vata
12. Pitta
13. Kapha
14. Prakriti
15. Herbs and supplements are regulated by the U.S. Food and Drug Administration.
16. True
17. False
18. When melatonin is used to induce sleep, the recommendation is that the patient:
19. Take 10 mg 30 minutes before bed nightly
20. Take 1 to 5 mg 30 minutes before bed nightly
21. Not take melatonin more than three nights a week
22. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep
23. 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:
24. Cardiac disturbances
25. Central nervous system depression
26. Respiratory depression
27. Skin rashes
28. The standard dosage of St John’s wort for the treatment of mild depression is:
29. 300 mg daily

2. 100 mg three times a day
3. 300 mg three times a day
4. 600 mg three times a day
5. Patients need to be instructed regarding the drug interactions with St John’s wort, including:
6. MAO inhibitors
7. Serotonin reuptake inhibitors
8. Over-the-counter cough and cold medications 4. All of the above
9. Ginseng, which is taken to assist with memory, may potentiate:
10. Aricept
11. Insulin
12. Digoxin
13. Propranolol
14. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
15. Antihypertensives, diuretics, and digoxin
16. Antidiarrheals, antihistamines, and omeprazole
17. Penicillin antibiotic class and benzodiazepines 4. None of the above
18. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
19. Respiratory depression
20. Cardiac disturbance
21. Salicylates poisoning
22. Life-threatening rashes
23. The role of the NP in the use of herbal medication is to:
24. Maintain competence in the prescribing of common herbal remedies
25. Recommend common over-the-counter herbs to patients
26. Educate patients and guide them to appropriate sources of care
27. Encourage patients to not use herbal therapy due to the documented dangers

Chapter 12. Pharmacoeconomics

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Pharmacoeconomics is: service
2. The direct costs of drug therapy include:
   1. The actual cost of acquiring the medication
   2. The loss of income due to illness
   3. Pain and suffering due to inadequate drug therapy
   4. The cost of a funeral associated with premature death
3. Indirect costs associated with drug therapy include:
   1. The cost of diagnostic tests to monitor therapeutic levels
   2. Health-care provider time to prescribe and educate the patient
   3. Child-care expenses incurred while receiving therapy
   4. Loss of wages while undergoing drug therapy
4. The intangible costs of drug therapy include: s
5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as:
   1. Cost-minimization analysis
   2. Cost-of-illness analysis
   3. Cost-effectiveness analysis
   4. Cost-benefit analysis
6. Cost-effectiveness analysis compares two or more treatments or programs that are:
   1. Not necessarily therapeutically equivalent
   2. Considered equal in efficacy
   3. Compared with the dollar value of the benefit received
7. The study of the part of the U.S. economy devoted to drug use
8. The study of the impact of prescription drug costs on the overall economy
9. The analysis of the costs and consequences of any health-care-related treatment or
10. The analysis of the clinical efficacy of the drug
11. Loss of wages while undergoing therapy
12. Inconvenience, pain, and suffering incurred with therapy
13. Cost of medical equipment in the laboratory used to monitor therapeutic drug level
14. Cost of prescription drug coverage, such as Medicare Part D

4. Expressed in terms of patient preference or quality-adjusted life years
5. When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as:
6. Cost-minimization analysis
7. Cost-of-illness analysis
8. Cost-effectiveness analysis
9. Cost-benefit analysis
10. Mary has a two-tiered prescription benefit plan, which means: provider m.
11. Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists: l patient ng less-
12. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:
13. The “donut hole” in Medicare Part D: m. . $2, $4, rage gap
14. Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in
15. She can receive differing levels of care based on whether she chooses an “in-plan” or not.
16. She is eligible for the new Medicare Part D “donut hole” reduction of costs progra
17. She pays a higher copay for brand-name drugs than for generic drugs.
18. She must always choose to be treated with generic drugs first.
19. Increases the complexity of the pharmacoeconomics of prescribing for the individua
20. Increases compliance by reducing the financial burden of drug costs to the patient
21. Is not sound prescribing practice due to the inferiority of the generic products
22. Will increase the overall cost of drugs to the system due to the ease of overprescribi expensive drugs
23. Order cognitive testing to determine the source of his confusion.
24. (^) Sit down with him and explain the whole Medicare Part D process.
25. Refer him to the Medicare specialist in his insurance plan to explain the benefit to hi
26. Request his son come to the next appointment so you can explain the benefit to him
27. Will be totally eliminated with the federal health-care reform enacted in 2010
28. Refers to the period of time when annual individual drug costs are between $250 and per year and drug costs are covered 75%
29. Refers^ to^ the period^ between^ when^ the^ annual individual^ drug^ costs^ are $2,970^ and and the patient pays 52.5% of the costs of brand name drugs (2013)
30. Has no effect on whether patients continue to fill their prescriptions during the cove

coverage they: n or a

Chapter 13. Over-the-Counter Medications

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. 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:
2. Be safe and labeled for appropriate use
3. Have a low potential for abuse or misuse
4. Be taken for a condition the patient can reliably self-diagnose 4. All of the above
5. 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
6. 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: tead of
7. New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do.
   1. True
   2. False
8. The ailment that generates the greatest over-the-counter annual drug sales is:
   1. Ask for extra refills of medication to get them through the months of no coverage
   2. Fill^ their^ prescriptions^ less^ frequently,^ including^ critical^ medications^ such^ as warfari statin
   3. Fill their critical medications, but hold off on filling less-critical medications
   4. Demonstrate no change in their prescription filling pattern
   5. Get a new patent for the over-the-counter form of the drug
   6. Lower the costs because most prescription benefit plans do not cover generics
   7. Market the drug to a whole new population, as they are able to market to patients ins just providers
   8. Continue to make large profits from their blockbuster brand-name drug

1. Constipation
2. Cough and colds
3. Heartburn
4. Acute and chronic pain
5. Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
6. Are always safer for the patient than prescription pain medication
7. Are harmful if taken in higher than recommended amounts
8. Have minimal interaction with prescription medications
9. Should never be given to children unless recommended by their provider
10. 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: e not an
11. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: ily and
12. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: nce

Chapter 15. Drugs Affecting the Central Nervous System

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial 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^ ar important part of his drug history
   4. A common misuse of over-the-counter aspirin
   5. Requires all providers to screen their patients for methamphetamine use
   6. Restricts the prescribing of amphetamines to U.S. citizens
   7. Requires a prescription be written for all methamphetamine precursors in all states
   8. Restricts the^ sales^ of^ drugs^ that^ contain^ methamphetamine^ precursors,^ including^ a da 30-day limit on sales
   9. Not to take their regularly prescribed medications while on these antibiotics
   10. Regarding the need for lots of acidic foods and juices, such as orange juice, to enha absorption
   11. Not to take antacids while on these medications, as the antacid decreases absorption
   12. That there are no drug interactions with these antibiotics

phentermine is prescribed. Prescribing precautions include:

1. Understanding that obesity is a contraindication to prescribing phentermine
2. Anorexiants may cause tolerance and should only be prescribed for 6 months
3. Patients should be monitored for postural hypotension
4. Renal function should be monitored closely while on anorexiants
5. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to:
6. Additive respiratory depression risk
7. Additive effects affecting liver function
8. The risk of serotonin syndrome
9. The risk of altered cognitive functioning
10. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for to be used for an episode of status epilepticus.
11. IV phenobarbital
12. Rectal diazepam (Diastat)
13. IV phenytoin (Dilantin)
14. Oral carbamazepine (Tegretol)
15. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
16. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
17. For pedal edema throughout therapy
18. Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
19. For vision changes, such as red-green blindness, at least annually
20. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:
21. Dwayne hasn’t been taking his carbamazepine because it causes insomnia.
22. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
23. Dwayne was not originally prescribed the correct amount of carbamazepine.
24. Carbamazepine is probably not the right antiseizure medication for Dwayne.
25. Carbamazepine has a Black Box Warning due to life-threatening:
26. Renal toxicity, leading to renal failure

2. Hepatotoxicity, leading to liver failure
3. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
4. Cardiac effects, including supraventricular tachycardia
5. Long-term monitoring of patients who are taking carbamazepine includes:
6. Routine troponin levels to assess for cardiac damage
7. Annual eye examinations to assess for cataract development
8. Monthly pregnancy tests for all women of childbearing age
9. Complete blood count every 3 to 4 months
10. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:
11. Increased seizure activity, as this drug may auto-induce seizures
12. Altered renal function, including renal failure
13. Blood dyscrasias, which are uncommon but possible
14. Central nervous system excitement, leading to insomnia
15. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:
16. Increase her dose
17. Assess for suicidal ideation
18. Discontinue the medication immediately
19. Decrease her dose to half then slowly titrate up the dose
20. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: her
21. Monitoring of a patient on gabapentin to treat seizures includes:
22. Routine therapeutic drug levels every 3 to 4 months
23. Assessing for dermatologic reactions, including Steven’s Johnson
24. Routine serum electrolytes, especially in hot weather
25. Recording seizure frequency, duration, and severity
26. Tell her to increase her caloric intake to counter the effects of the topiramate.
27. Consult with a neurologist, as this is not a common adverse effect of topiramate.
28. Decrease her dose of topiramate.
29. Reassure^ her^ that^ this^ is^ a normal^ side^ effect^ of^ topiramate^ and^ continue^ to^ monitor weight.

12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:
13. He should not play sports due to the risk of increased seizures
14. He should monitor his temperature and ability to sweat in the heat while playing
15. Reminding him that he may need higher dosages of topiramate when exercising
16. Encouraging him to use sunscreen due to photosensitivity from topiramate
17. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:
18. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
19. To wear sunscreen due to photosensitivity from levetiracetam
20. To get an annual eye exam while on levetiracetam
21. To report weight loss if it occurs
22. Levetiracetam has known drug interactions with:
    1. Combined oral contraceptives
    2. Carbamazepine
    3. Warfarin
    4. Few, if any, drugs
23. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:
    1. Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days
    2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
    3. Rapid strep test and symptomatic care if strep test is negative
    4. Observation only, with further assessment if she worsens
24. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: bed
25. The tricyclic antidepressants should be prescribed cautiously in patients with:
    1. Eczema
    2. Asthma
    3. Diabetes
26. Contraceptive failure
27. Excessive weight gain
28. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
29. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescri