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Chapter 2. Review of Basic Principles of Pharmacology
- A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This iscritical to prescribing because: Distribution of drugs to target tissue may be affected.
- Drugs that have a significant first-pass effect: Are rapidly metabolized by the liver and may have little if any desired action 3.The route of excretion of a volatile drug will likely be the:
Lungs
- Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create astorage reservoir Increase the length of time a drug is available and active
- The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:Biological half-life
- Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 daysof the prescription. This is considered a loading dose. A loading dose: Rapidly achieves drug levels in the therapeutic range
- The point in time on the drug concentration curve that indicates the first sign of atherapeutic effect is the: Onset of action
- Phenytoin requires that a trough level be drawn. Peak and trough levels are done:To determine if a drug is in the therapeutic range
- A laboratory result indicates that the peak level for a drug is above the minimum toxicconcentration. This means that the: Concentration will produce an adverse response
- Drugs that are receptor agonists may demonstrate what property?Desensitization or downregulation with continuous use
- Drugs that are receptor antagonists, such as beta blockers, may cause:An exaggerated response if abruptly discontinued
- Factors that affect gastric drug absorption
include:Lipid solubility of the drug
Neither Protein malnutrition OR Iron-deficiency anemia
- The time required for the amount of drug in the body to decrease by 50% is called:Half-life
- An agonist activates a receptor and stimulates a response. When given frequently over time,the body may: Downregulate the numbers of that specific receptor
- Drug antagonism is best defined as an effect of a drug that: Is modified by the concurrent administration of another drug 27.Instructions to a client regarding self-administration of oral enteric-coated tablets shouldinclude which of the following statements? “To achieve best effect, take the tablet with at least 8 ounces of fluid.”
- The major reason for not crushing a sustained-release capsule is that, if crushed, thecoated beads of the drugs could possibly result in: Toxicity
- Which of the following substances is the most likely to be absorbed in the intestines ratherthan in the stomach? Sodium bicarbonate
- Which of the following variables is a factor in drug absorption? A rich blood supply to the area of absorption leads to better absorption
- An advantage of prescribing a sublingual medication is that the medication is:Absorbed rapidly
- Drugs that use CYP 3A4 isoenzymes for metabolism may: Induce and inhibit the metabolism of another drug
- Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steadystate: After four to five half-lives
- Upregulation or hypersensitization may lead to: An exaggerated response if the drug is withdrawn
Chapter 7. Cultural and Ethnic Influences in
Pharmacotherapeutics
- Cultural factors that must be taken into account when prescribing include(s):
The patient’s view of health and illness
- Ethnic differences have been found in drug:
Hepatic metabolism
- The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all: Organizations that receive federal funds
- According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care: Must be a professionally trained medical interpreter
- According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: Discrimination, cultural barriers, and lack of access to health care
- The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: Largely unknown due to lack of studies of this population
- Pharmacokinetics among Asians are universal to all the Asian ethnic groups. False
- Alterations in drug metabolism among Asians may lead to: Slower metabolism of antidepressants, requiring lower doses 9.Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
Require higher doses of drugs metabolized by acetylization to achieve efficacy
- Hispanic native healers ( curanderas ):
Use herbs and teas in their treatment of illness
Chapter 8. An Introduction to Pharmacogenomics
- Genetic polymorphisms account for differences in metabolism,
including:Poor metabolizers, who lack a working enzyme
Intermediate metabolizers, who have one working, wild-type allele and one mutant allele Extensive metabolizers, with two normally functioning alleles
- Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
- Rifampin is a nonspecific CYP450 inducer that may:
Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
- Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
- Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
Decreased response to warfarin
- Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required priorto prescribing warfarin. False
- Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior toprescribing: Cetuximab
- 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: Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B* allele
- A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated bythe body may lead to: Increased adverse drug reactions, such as neutropenia
- Patients who have a poor metabolism phenotype will have:
Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
- Ultra-rapid metabolizers of drugs may have:
Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
- The U.S. Drug Enforcement Administration:
Registers manufacturers and prescribers of controlled substances
- Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration:
May not be refilled; a new prescription must be written
- Precautions that should be taken when prescribing controlled substances include:Using tamper-proof paper for all prescriptions written for controlled drugs
- Strategies prescribers can use to prevent misuse of controlled prescription drugs include:Use of chemical dependency screening tools
Firm limit-setting regarding prescribing controlled substances Practicing “just say no” to deal with patients who are pushing the provider to prescribe controlled substances
- Behaviors predictive of addiction to controlled substances include:Stealing or borrowing another patient’s drugs
- Medication agreements or “Pain Medication Contracts” are recommended to be used:Universally for all prescribing for chronic pain
- A prescription needs to be written for:Legend drugs
Most controlled drugs Medical devices
Chapter 13. Over-the-Counter Medications
- Michael asks you about why some drugs are over-the-counter and some are prescription. Youexplain that in order for a drug to be approved for over-the-counter use the drug must: Be safe and labeled for appropriate use Have a low potential for abuse or misuse
Be taken for a condition the patient can reliably self-diagnose
- In the United States, over-the-counter drugs are regulated by:
4.New over-the-counter drug ingredients must undergo the U.S. Food and Drug AdministrationNew Drug Application process, just as prescription drugs do. True 5.The ailment that generates the greatest over-the-counter annual drug sales is:Cough and colds
- Common over-the-counter pain relievers such as acetaminophen or ibuprofen:Are harmful if taken in higher than recommended amounts
- 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 takesaspirin for his arthritis flare ups. This is an example of: A common misconception that intermittently taken over-the counter medications are not an important part of his drug history
- The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:
Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales
- When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:Not to take antacids while on these medications, as the antacid decreases
absorption
Chapter 25. Drugs Used in Treating Inflammatory Processes
- Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? Low-dose colchicine
- Patient education when prescribing colchicine
includes:Colchicine always causes some degree of diarrhea. 3.Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: BUN, creatinine, and creatinine clearance
- Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostatincludes:
Gout may worsen with therapy.
15.Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburnfrom the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? Add an H 2 blocker such as ranitidine to his therapy. 16.The trial period to determine effective anti-inflammatory activity when starting a patient onaspirin for rheumatoid arthritis is: 4 to 6 days
- Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity.An early sign of aspirin toxicity is: Tinnitus 18.Monitoring a patient on a high-dose aspirin level includes:Salicylate level
Complete blood count Urine pH
- Patients who are on long-term aspirin therapy should have annually. Complete blood count
Chapter 52. Pain Management: Acute and Chronic Pain
- Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the: Motivational aspects of pain
- Patients need to be questioned about all pain sites because:
Patients tend to report the most severe or important in their perception.
- The chemicals that promote the spread of pain locally
include:Neurokinin A
- Narcotics are exogenous opiates. They act by: Attaching to receptors in the afferent neuron to inhibit the release of substance P
- Age is a factor in different responses to pain. Which of the following age-related statementsabout pain is NOT true? Preterm and newborn infants do not yet have functional pain pathways.
6.Which of the following statements is true about acute pain?
Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.
- One of the main drug classes used to treat acute pain is NSAIDs. They are used
because:Inflammation is a common cause of acute pain.
- Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT trueabout these drugs?
Opiates stimulate only mu receptors for the control of pain. 9.If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in whichorder of use?
Non-opiate, increased dose of non-opiate, opiate
- The goal of treatment of acute pain is:
Reduction or elimination of pain with minimum adverse reactions
- Which of the following statements is true about age and pain?
Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.
- Pain assessment to determine adequacy of pain management is important for all patients.This assessment is done to: Determine if the diagnosis of source of pain is correct Determine if the current regimen is adequate or different combinations of drugs and non- drug therapy are required Determine if the patient is willing and able to be an active participant in his or her pain management
- Pathological similarities and differences between acute pain and chronic pain
include:Chronic pain has a predominance of C-neuron stimulation.
- A treatment plan for management of chronic pain should include:
Negotiation with the patient to set personal goals for pain managementDiscussion of ways to improve sleep and stress
An exercise program to improve function and fitness
- Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? Extend the dosage interval.
- Beta blockers are the drugs of choice for exertional angina because they: Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
- Adherence to beta blocker therapy may be affected by their: Effects on the male genitalia, which may produce impotence
- Beta blockers have favorable effects on survival and disease progression in heart failure.Treatment should be initiated when the: Left ventricular dysfunction is diagnosed
- Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for seriousconsequences of rapid withdrawal are those with: Angina Coronary artery disease
- To prevent life-threatening events from rapid withdrawal of a beta
blocker:The dosage should be decreased by one-half every 4 days.
- Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possibledecreased blood glucose? Diaphoresis
- Combined alpha-beta antagonists are used to reduce the progression of heart failure becausethey: Vasodilate the peripheral vasculature
- Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? Histamine 2 blockers Quinolones
Serotonin re-uptake inhibitors
- Alpha-beta blockers are especially effective to treat hypertension for which ethnic
group?African American
- Bethanechol:
Increases detrusor muscle tone to empty the bladder
- Clinical dosing of Bethanechol:
Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved
- Patients who need to remain alert are taught to avoid which drug due to its antimuscariniceffects? Diphenhydramine
- Anticholinesterase inhibitors are used to treat:Myasthenia gravis
- Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?Memantine
- Taking which drug with food maximizes it bioavailability?
Rivastigmine
- Which of the following drugs should be used only when clearly needed in pregnant andbreastfeeding women? Pyridostigmine
- There is a narrow margin between first appearance of adverse reaction to AChE inhibitorsand serious toxic effects. Adverse reactions that require immediate action include: Fasciculations of voluntary muscles
- Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? Donepezil
- Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of thefollowing is NOT an effect of nicotine? Vasodilation and decreased heart rate Effects of nicotine include: Increased secretion of gastric acid and motility of the GI smooth muscle, Release of dopamine at the pleasure center & Stimulation of the
