Pharmacotherapeutics for Advanced Practice Nurse Prescribers Exam Questions with Answers L, Exams of Nursing

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Pharmacotherapeutics for Advanced Practice

Nurse Prescribers Exam Questions with

Answers Latest Update 2024

Drugs that use CYP 3A4 is enzymes for metabolism may:

1. Induce the metabolism of another drug
2. Inhibit the metabolism of another drug
3. Both 1 and 2
4. Neither 1 nor 2 - Correct Answers 3 Medication agreements or "Pain Medication Contracts" are recommended to be used:
5. Universally for all prescribing for chronic pain
6. For patients who have repeated requests for pain medication
7. When you suspect a patient is exhibiting drug-seeking behavior
8. For patients with pain associated with malignancy - Correct Answers 1 Drugs that are prone to cause adverse drug effects include:
9. Diuretics
10. Inhaled anticholinergic
11. Insulin’s
12. Stimulants - Correct Answers 3 The U.S. Food and Drug Administration MedWatch system is activated when:
13. There is an adverse event to a vaccine.
14. The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication label.

3. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
4. An adverse event or serious problem occurs with a medication that is not already identified on the label. - Correct Answers 4 The Vaccine Adverse Events Reporting System is:
5. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event
6. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events
7. Utilized to send out safety alerts regarding emerging vaccine safety issues
8. Activated when a vaccine has been proven to cause significant adverse effects - Correct Answers 2 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?
9. Financial status
10. Mobility
11. Social support
12. Sexual practices - Correct Answers 4 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?
13. Use correct medical terminology because Spanish has a Latin base.
14. Use a family member who speaks more English to act as an interpreter.
15. Use a professional interpreter or a reliable staff member who can act as an interpreter.
16. Use careful, detailed explanations. - Correct Answers 3 Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?

1. Stand facing him and speak slowly and clearly.
2. Speak in low tones or find a provider who has a lower voice.
3. Write down the instructions as well as speaking them.
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. - Correct Answers 4 Which of the following factors may adversely affect a patient's adherence to a therapeutic drug regimen?
5. Complexity of the drug regimen
6. Patient perception of the potential adverse effects of the drugs
7. Both 1 and 2
8. Neither 1 nor 2 - Correct Answers 3 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?
9. Increasing copayments for care
10. Unrestricted formularies for drugs, including brand names
11. Increasing the number of people who have access to care
12. Treating a wider range of disorders - Correct Answers 1 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?
13. Ralph states that he always takes the drug "when I feel my pressure is going up."
14. Ralph contacts his NP to discuss the need to increase the dosage.
15. Ralph consistently keeps his follow-up appointments to check his blood pressure.
16. All of the above show that he is adherent to the drug regimen. - Correct Answers 1

No adherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of no adherence to these drugs is to prescribe a drug that:

1. Has a short half-life so that missing one dose has limited effect
2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
3. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
4. Must be taken no more than twice a day - Correct Answers 3 Factors in chronic conditions that contribute to no adherence include:
5. The complexity of the treatment regimen
6. The length of time over which it must be taken
7. Breaks in the usual daily routine, such as vacations and weekends
8. All of the above - Correct Answers 4 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:
9. The provider spent a lot of time discussing the drugs with them
10. Their concerns and specific area of knowledge deficit were addressed
11. They were given written material, such as pamphlets, about the drugs
12. The provider used appropriate medical and pharmacological terms - Correct Answers 2 Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:
13. With a longer half-life so that missed doses produce a longer taper on the drug curve
14. In oral formulations that are more easily taken
15. That does not require frequent monitoring

4. Combined with patient education about the need to adhere even when symptoms are absent - Correct Answers 1 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?
5. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing.
6. Match the clinic appointment to the next time the drug is to be refilled.
7. Write prescriptions for new drugs with shorter times between refills.
8. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. - Correct Answers 4 Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
9. Older adults and those on fixed incomes
10. Patients with chronic illnesses
11. Patients with copayments for drugs on their insurance
12. Patients on public assistance - Correct Answers 1 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:
13. Are well-educated and affluent
14. Have chronic conditions
15. Self-monitor drug effects on their symptoms
16. None of the above guarantee adherence - Correct Answers 4 Monitoring adherence can take several forms, including:
17. Patient reports from data in a drug diary
18. Pill counts

3. Laboratory reports and other diagnostic markers
4. All of the above - Correct Answers 4 Factors that explain and predict medication adherence include:
5. Social
6. Financial
7. Health system
8. All of the above - Correct Answers 4 Cultural factors that must be taken into account when prescribing include(s):
9. Who the decision maker is in the family regarding health-care decisions
10. The patient's view of health and illness
11. Attitudes regarding the use of drugs to treat illness
12. All of the above - Correct Answers 4 Ethnic differences have been found in drug:
13. Absorption
14. Hepatic metabolism
15. Filtration at the glomerulus
16. Passive tubular reabsorption - Correct Answers 2 The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:
17. Hospitals
18. Clinics that serve the poor
19. Organizations that receive federal funds
20. Clinics that serve ethnic minorities - Correct Answers 3

According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:

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

3. Altered metabolism of omeprazole, requiring higher doses
4. Slower metabolism of alcohol, requiring higher doses - Correct Answers 1 Asians from Eastern Asia are known to be fast acetylates. Fast acetylates:
5. Require acetylation in order to metabolize drugs
6. Are unable to tolerate higher doses of some drugs that require acetylation
7. May have a toxic reaction to drugs that require acetylation
8. Require higher doses of drugs metabolized by acetylation to achieve efficacy - Correct Answers 4 Hispanic native healers (corianders):
9. Are not heavily utilized by Hispanics who immigrate to the United States
10. Use herbs and teas in their treatment of illness
11. Provide unsafe advice to Hispanics and should not be trusted
12. Need to be licensed in their home country in order to practice in the United States - Correct Answers 2 Genetic polymorphisms account for differences in metabolism, including:
13. Poor metabolizers, who lack a working enzyme
14. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele
15. Extensive metabolizers, with two normally functioning alleles
16. All of the above - Correct Answers 4 Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
17. A need to monitor drugs metabolized by 2D6 for toxicity
18. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
19. Decreased conversion of codeine to morphine by CYP 2D

4. The need for lowered dosages of drugs, such as beta blockers - Correct Answers 2 Rifampin is a nonspecific CYP450 inducer that may:
5. Lead to toxic levels of rifampin and must be monitored closely
6. Cause toxic levels of drugs, such as oral contraceptives, when administered
7. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
8. Cause nonspecific changes in drug metabolism - Correct Answers 3 Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
9. Decreased therapeutic levels of quinidine
10. Increased therapeutic levels of quinidine
11. Decreased levels of a administered drug, such as digoxin, that requires P- glycoprotein for absorption and elimination
12. Increased levels of a administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination - Correct Answers 4 Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
13. Toxic levels of warfarin building up
14. Decreased response to warfarin
15. Increased risk for significant drug interactions with warfarin
16. Less risk of drug interactions with warfarin - Correct Answers 2 Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
17. True
18. False - Correct Answers 2 Pharmacokinetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

1. Erythromycin
2. Digoxin
3. Cetuximab
4. Rifampin - Correct Answers 3 Carbamazepine has a Black Box Warning recommending testing for the HLA-B* allele in patients with Asian ancestry prior to starting therapy due to:
5. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele
6. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele
7. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B* allele
8. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine - Correct Answers 3 A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:
9. Decreased effectiveness of irinotecan in the treatment of cancer
10. Increased adverse drug reactions, such as neutropenia
11. Delayed metabolism of the prod rug irinotecan into the active metabolite SN-
12. Increased concerns for irinotecan being carcinogenic - Correct Answers 2 Patients who have a poor metabolism phenotype will have:
13. Slowed metabolism of a prod rug into an active drug, leading to accumulation of prod rug
14. Accumulation of inactive metabolites of drugs
15. A need for increased dosages of medications
16. Increased elimination of an active drug - Correct Answers 1 Ultra-rapid metabolizers of drugs may have:

1. To have dosages of drugs adjusted downward to prevent drug accumulation
2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
3. Increased elimination of active, no metabolized drug
4. Slowed metabolism of a prod rug into an active drug, leading to an accumulation of prod rug - Correct Answers 2 A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
5. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
6. Identify potential drug-drug interactions that may occur with tamoxifen
7. Reduce the likelihood of therapeutic failure with tamoxifen treatment
8. Identify poor metabolizers of tamoxifen - Correct Answers 3 A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States is using herbal products.
9. 10
10. 5
11. 38
12. 70 - Correct Answers 3 A potential harmful effect on patients who take some herbal medication is:
13. Constipation
14. Lead poisoning
15. Diarrhea
16. Life-threatening rash - Correct Answers 2 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. Coumadin, which can cause liver and kidney damage
3. Cinnamon aldehyde, which is toxic to the kidney
4. Cinematic eugenic, which is toxic to the liver - Correct Answers 2 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:
5. Herbs which are yang in nature
6. Herbs that are yin in nature
7. Ginger
8. Golden seal - Correct Answers 2 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:
9. Get worse
10. Get better
11. Not be adequately treated
12. Need additional herbs to treat the yen - Correct Answers 1 In Ayurveda medicine, treatment is based on the patient's dominant dish, which is referred to as the person's:
13. Vat
14. Pitta
15. Kappa
16. Priority - Correct Answers 4 Herbs and supplements are regulated by the U.S. Food and Drug Administration.
17. True

2. False - Correct Answers 2 When melatonin is used to induce sleep, the recommendation is that the patient:
3. Take 10 mg 30 minutes before bed nightly
4. Take 1 to 5 mg 30 minutes before bed nightly
5. Not take melatonin more than three nights a week
6. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep - Correct Answers 3 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:
7. Cardiac disturbances
8. Central nervous system depression
9. Respiratory depression
10. Skin rashes - Correct Answers 1 The standard dosage of St John's wort for the treatment of mild depression is:
11. 300 mg daily
12. 100 mg three times a day
13. 300 mg three times a day
14. 600 mg three times a day - Correct Answers 3 Patients need to be instructed regarding the drug interactions with St John's wort, including:
15. MAO inhibitors
16. Serotonin reuptake inhibitors
17. Over-the-counter cough and cold medications
18. All of the above - Correct Answers 4 Ginseng, which is taken to assist with memory, may potentiate:

1. Aricept
2. Insulin
3. Digoxin
4. Propranolol - Correct Answers 2 Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
5. Antihypertensives, diuretics, and digoxin
6. Antidiarrheals, antihistamines, and omeprazole
7. Penicillin antibiotic class and benzodiazepines
8. None of the above - Correct Answers 1 Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
9. Respiratory depression
10. Cardiac disturbance
11. Salicylates poisoning
12. Life-threatening rashes - Correct Answers 3 The role of the NP in the use of herbal medication is to:
13. Maintain competence in the prescribing of common herbal remedies
14. Recommend common over-the-counter herbs to patients
15. Educate patients and guide them to appropriate sources of care
16. Encourage patients to not use herbal therapy due to the documented dangers - Correct Answers 3 Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:
17. Search for information using the most common search engines

2. Serve as content experts in developing, implementing, and evaluating information systems
3. Write programs to assure the integrity of health information
4. Use information technology to prescribe drugs - Correct Answers 2 You are going to prescribe a drug and the electronic health record (EHR) alerts you that there is a potential drug-drug interaction. The alert is generated by:
5. The Food and Drug Administration MedWatch system
6. TOXNET, the National Institutes of Health alert system
7. The EHR clinical decision support system
8. Lexicomp, a commercial medication alert system - Correct Answers 3 Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?
9. Reduces time that prescribing drugs takes
10. Eliminates the need to chart drugs prescribed
11. Decreases prescribing and transcription errors
12. Helps keep the number of drugs prescribed to a minimum - Correct Answers 3 A number of barriers and concerns exist before the goals of a safe and efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs?
13. Cost of initial setup
14. Access to highly skilled experts
15. Compatibility between systems
16. Patient confidentiality risks - Correct Answers 2 EHRs:
17. Are being discouraged by the Centers for Medicare and Medicaid Services due to cost issues

2. Allow for all patient data to be centralized in one location for access by multiple providers
3. Use macros and templates to individualize care
4. Use standardized software to facilitate interoperability between systems - Correct Answers 2 Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:
5. Designing software so that only those who need the information can gain access
6. Requiring providers to log off at the end of the clinical day
7. Keeping a file of the login and password information for each provider in a secure place
8. Having patients sign informed consent documents to have their data on an EHR - Correct Answers 1 Decision support systems often provide medication alerts that tell the prescriber:
9. Patient history data with a summary of their diagnoses
10. The usual dosage for the drug being prescribed
11. The patient's latest laboratory values, such as potassium levels
12. Potential drug-to-drug interactions with other medications the patient is taking - Correct Answers 4 Prescribers have been shown to override a medication alert about a patient's allergies when:
13. The history showed that the patient had tolerated the medication in the past
14. The benefit outweighed the risk
15. The medication was therapeutically appropriate and needed
16. All of the above - Correct Answers 4

The use of information technology for quality improvement in pharmacotherapeutics includes:

1. Incorporating the use of "apps" into all patient encounters
2. Tracking data trends within the practice via the electronic health record database
3. Informing patients that they have access to their medication list via the Internet
4. Using macros for individualizing patient care management - Correct Answers 2 The advantage of using information technology for patient education includes:
5. The ability to track the number of times you have given the patient the same instructions regarding their medication
6. Standardized and individualized patient education that is simultaneously recorded into the patient record
7. Easy access to private patient information specific to populations with a similar diagnosis
8. The ability to download and interpret patient information in multiple languages, easily and accurately - Correct Answers 2 One barrier to use of the Internet for both prescribing and for patient teaching is:
9. Lack of free public access to the Internet
10. Age, with older adults rarely understanding how to use a computer
11. Web pages and hyperlinks may change, be deleted, or be replaced
12. Few Web sites with information about drugs are free - Correct Answers 3 Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to:
13. Prioritize what is needed information and avoid spending time reading "interesting" information not central to the problem at hand
14. Integrate professional and personal searching so that the same browser does not need to be accessed repeatedly
15. Check e-mail frequently so that patient questions can be addressed promptly

4. Check for viruses, spyware, and malware - Correct Answers 1 Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review:
5. The patient's current diagnosis and history
6. Drugs the patient is currently taking
7. Any recent previous encounter for the same problem as this visit and what was done
8. All of the above - Correct Answers 4 nformation technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true?
9. Patients feel the provider does not care about them if they are not seen in a face-to- face encounter.
10. Data collected from patients between encounters via IT is less accurate and complete.
11. Collecting data between encounters via IT may mean a more efficient face-to-face encounter.
12. Between encounters is a good time to collect screening data. - Correct Answers 3 Discharge summaries using information technology have several advantages. They can:
13. Replace the need for oral instruction because the patient has printed material to read at home
14. Be filed with the patient's chart to document patient teaching
15. Both 1 and 2
16. Neither 1 nor 2 - Correct Answers 2 Information technology can also be used for patient teaching during the encounter and after it. The provider can help patients and their families become savvy consumers of health-care information by:
17. Warning them about the questionable quality of health information online
18. Identifying easily used "apps" that patients can use to manage their medications

3. Teaching them how to identify high-quality Web sites and "red flags" signaling inaccurate content
4. All of the above - Correct Answers 3 Incorporating information technology (IT) into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:
5. Turning the screen around so the patient can see material being recorded
6. Not placing the computer screen between the provider and the patient
7. Both 1 and 2
8. Neither 1 nor 2 - Correct Answers 3 Pharmacoeconomics is:
9. The study of the part of the U.S. economy devoted to drug use
10. The study of the impact of prescription drug costs on the overall economy
11. The analysis of the costs and consequences of any health-care-related treatment or service
12. The analysis of the clinical efficacy of the drug - Correct Answers 3 The direct costs of drug therapy include:
13. The actual cost of acquiring the medication
14. The loss of income due to illness
15. Pain and suffering due to inadequate drug therapy
16. The cost of a funeral associated with premature death - Correct Answers 3 Indirect costs associated with drug therapy include:
17. The cost of diagnostic tests to monitor therapeutic levels
18. Health-care provider time to prescribe and educate the patient
19. Child-care expenses incurred while receiving therapy

4. Loss of wages while undergoing drug therapy - Correct Answers 4 The intangible costs of drug therapy include:
5. Loss of wages while undergoing therapy
6. Inconvenience, pain, and suffering incurred with therapy
7. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels
8. Cost of prescription drug coverage, such as Medicare Part D - Correct Answers 2 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:
9. Cost-minimization analysis
10. Cost-of-illness analysis
11. Cost-effectiveness analysis
12. Cost-benefit analysis - Correct Answers 1 Cost-effectiveness analysis compares two or more treatments or programs that are:
13. Not necessarily therapeutically equivalent
14. Considered equal in efficacy
15. Compared with the dollar value of the benefit received
16. Expressed in terms of patient preference or quality-adjusted life years - Correct Answers 1 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:
17. Cost-minimization analysis
18. Cost-of-illness analysis
19. Cost-effectiveness analysis
20. Cost-benefit analysis - Correct Answers 4

Mary has a two-tiered prescription benefit plan, which means:

1. She can receive differing levels of care based on whether she chooses an "in-plan" provider or not.
2. She is eligible for the new Medicare Part D "donut hole" reduction of costs program.
3. She pays a higher copay for brand-name drugs than for generic drugs.
4. She must always choose to be treated with generic drugs first. - Correct Answers 3 Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists:
5. Increases the complexity of the pharmacoeconomics of prescribing for the individual patient
6. Increases compliance by reducing the financial burden of drug costs to the patient
7. Is not sound prescribing practice due to the inferiority of the generic products?
8. Will increase the overall cost of drugs to the system due to the ease of overprescribing less-expensive drugs - Correct Answers 2 James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:
9. Order cognitive testing to determine the source of his confusion.
10. Sit down with him and explain the whole Medicare Part D process.
11. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him.
12. Request his son come to the next appointment so you can explain the benefit to him.

• Correct Answers 3 The "donut hole" in Medicare Part D:

1. Will be totally eliminated with the federal health-care reform enacted in 2010
2. Refers to the period of time when annual individual drug costs are between $250 and $2,250 per year and drug costs are covered 75%
3. Refers to the period between when the annual individual drug costs are $2,970 and $4,750 and the patient pays 52.5% of the costs of brand name drugs (2013)

4. Has no effect on whether patients continue to fill their prescriptions during the coverage gap - Correct Answers 3 Research has shown that when patients who are covered by Medicare Part D reach the "donut hole" in coverage they:
5. Ask for extra refills of medication to get them through the months of no coverage
6. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin
7. Fill their critical medications, but hold off on filling less-critical medications
8. Demonstrate no change in their prescription filling pattern - Correct Answers 2 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:
9. Be safe and labeled for appropriate use
10. Have a low potential for abuse or misuse
11. Be taken for a condition the patient can reliably self-diagnose
12. All of the above - Correct Answers 4 In the United States, over-the-counter drugs are regulated by:
13. No one. There is no oversight for over-the-counter medications.
14. The U.S. Food and Drug Administration Center for Drug Evaluation and Research
15. The U.S. Drug Enforcement Administration
16. MedWatch - Correct Answers 2 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:
17. Get a new patent for the over-the-counter form of the drug
18. Lower the costs because most prescription benefit plans do not cover generics
19. Market the drug to a whole new population, as they are able to market to patients instead of just providers

4. Continue to make large profits from their blockbuster brand-name drug - Correct Answers 4 New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do.
5. True
6. False - Correct Answers 1 The ailment that generates the greatest over-the-counter annual drug sales is:
7. Constipation
8. Cough and colds
9. Heartburn
10. Acute and chronic pain - Correct Answers 2 Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
11. Are always safer for the patient than prescription pain medication
12. Are harmful if taken in higher than recommended amounts
13. Have minimal interaction with prescription medications
14. Should never be given to children unless recommended by their provider - Correct Answers 2 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:
15. His appropriately only telling you about his regularly prescribed medications
16. His hiding information regarding his inappropriate use of aspirin from you
17. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history
18. A common misuse of over-the-counter aspirin - Correct Answers 3 The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:

1. Requires all providers to screen their patients for methamphetamine use
2. Restricts the prescribing of amphetamines to U.S. citizens
3. Requires a prescription be written for all methamphetamine precursors in all states
4. Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales - Correct Answers 4 When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:
5. Not to take their regularly prescribed medications while on these antibiotics
6. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption
7. Not to take antacids while on these medications, as the antacid decreases absorption
8. That there are no drug interactions with these antibiotics - Correct Answers 3 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?
9. High-dose colchicine
10. Low-dose colchicine
11. High-dose aspirin
12. Acetaminophen with codeine - Correct Answers 2 Patient education when prescribing colchicine includes:
13. Colchicine may be constipating.
14. Colchicine always causes some degree of diarrhea.
15. Mild muscle weakness is normal.
16. Moderate amounts of alcohol are safe with colchicine. - Correct Answers 2 Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
17. Complete blood count

2. Blood glucose
3. C-reactive protein
4. BUN, creatinine, and creatinine clearance - Correct Answers 4 Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
5. Gout may worsen with therapy.
6. Febuxostat may cause severe diarrhea.
7. He should consume a high-calcium diet.
8. He will need frequent CBC monitoring. - Correct Answers 1 Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:
9. Gout
10. Iron deficiency anemia
11. Osteoporosis
12. Renal dysfunction - Correct Answers 3 Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
13. Metformin, a biguanide to prevent diabetes
14. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
15. Naproxen, an NSAID to treat joint pain
16. Furosemide, a diuretic to treat fluid retention - Correct Answers 2 Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
17. Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids.