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Pharmacotherapeutics for Advanced Practice Nurse Prescribers questions and answers, Exams of Nursing

Pharmacotherapeutics for Advanced Practice Nurse Prescribers questions and answers

Typology: Exams

2023/2024

Available from 02/17/2024

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Pharmacotherapeutics for Advanced Practice

Nurse Prescribers questions and answers

Drugs that use CYP 3A4 isoenzymes 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 - 3

Medication agreements or "Pain Medication Contracts" are recommended to be used:

  1. Universally for all prescribing for chronic pain
  2. For patients who have repeated requests for pain medication
  3. When you suspect a patient is exhibiting drug-seeking behavior
  4. For patients with pain associated with malignancy - 1

Drugs that are prone to cause adverse drug effects include:

  1. Diuretics
  2. Inhaled anticholinergics
  3. Insulins
  4. Stimulants - 3

The U.S. Food and Drug Administration MedWatch system is activated when:

  1. There is an adverse event to a vaccine.
  2. 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. - 4

The Vaccine Adverse Events Reporting System is:

  1. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event
  2. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events
  3. Utilized to send out safety alerts regarding emerging vaccine safety issues
  4. Activated when a vaccine has been proven to cause significant adverse effects - 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?

  1. Financial status
  2. Mobility
  3. Social support
  4. Sexual practices - 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?

  1. Use correct medical terminology because Spanish has a Latin base.
  2. Use a family member who speaks more English to act as an interpreter.
  3. Use a professional interpreter or a reliable staff member who can act as an interpreter.
  4. Use careful, detailed explanations. - 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.
  1. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. - 4

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
  4. Neither 1 nor 2 - 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?

  1. Increasing copayments for care
  2. Unrestricted formularies for drugs, including brand names
  3. Increasing the number of people who have access to care
  4. Treating a wider range of disorders - 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?

  1. Ralph states that he always takes the drug "when I feel my pressure is going up."
  2. Ralph contacts his NP to discuss the need to increase the dosage.
  3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
  4. All of the above show that he is adherent to the drug regimen. - 1

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:

  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
  1. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
  2. Must be taken no more than twice a day - 3

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 - 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:

  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 - 2

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:

  1. With a longer half-life so that missed doses produce a longer taper on the drug curve
  2. In oral formulations that are more easily taken
  3. That do not require frequent monitoring
  4. Combined with patient education about the need to adhere even when symptoms are absent - 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?

  1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing.
  1. Match the clinic appointment to the next time the drug is to be refilled.
  2. Write prescriptions for new drugs with shorter times between refills.
  3. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. - 4

Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:

  1. Older adults and those on fixed incomes
  2. Patients with chronic illnesses
  3. Patients with copayments for drugs on their insurance
  4. Patients on public assistance - 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:

  1. Are well-educated and affluent
  2. Have chronic conditions
  3. Self-monitor drug effects on their symptoms
  4. None of the above guarantee adherence - 4

Monitoring adherence can take several forms, including:

  1. Patient reports from data in a drug diary
  2. Pill counts
  3. Laboratory reports and other diagnostic markers
  4. All of the above - 4

Factors that explain and predict medication adherence include:

  1. Social
  2. Financial
  1. Health system
  2. All of the above - 4

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 - 4

Ethnic differences have been found in drug:

  1. Absorption
  2. Hepatic metabolism
  3. Filtration at the glomerulus
  4. Passive tubular reabsorption - 2

The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:

  1. Hospitals
  2. Clinics that serve the poor
  3. Organizations that receive federal funds
  4. Clinics that serve ethnic minorities - 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 - 3

According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

  1. The belief among African Americans that prayer is more powerful than drugs
  2. Poor compliance on the part of the African American patient
  3. The genetic predisposition for illness found among African Americans
  4. Discrimination, cultural barriers, and lack of access to health care - 4

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 - 2

Pharmacokinetics among Asians are universal to all the Asian ethnic groups.

  1. True
  2. False - 2

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 - 1

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
  1. Require higher doses of drugs metabolized by acetylization to achieve efficacy - 4

Hispanic native healers (curanderas):

  1. Are not heavily utilized by Hispanics who immigrate to the United States
  2. Use herbs and teas in their treatment of illness
  3. Provide unsafe advice to Hispanics and should not be trusted
  4. Need to be licensed in their home country in order to practice in the United States - 2

Genetic polymorphisms account for differences in metabolism, including:

  1. Poor metabolizers, who lack a working enzyme
  2. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele
  3. Extensive metabolizers, with two normally functioning alleles
  4. All of the above - 4

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

  1. A need to monitor drugs metabolized by 2D6 for toxicity
  2. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
  3. Decreased conversion of codeine to morphine by CYP 2D
  4. The need for lowered dosages of drugs, such as beta blockers - 2

Rifampin is a nonspecific CYP450 inducer that may:

  1. Lead to toxic levels of rifampin and must be monitored closely
  2. Cause toxic levels of drugs, such as oral contraceptives, when coadministered
  3. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
  4. Cause nonspecific changes in drug metabolism - 3

Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

  1. Decreased therapeutic levels of quinidine
  2. Increased therapeutic levels of quinidine
  3. Decreased levels of a coadministered drug, such as digoxin, that requires P- glycoprotein for absorption and elimination
  4. Increased levels of a coadministered drug, such as digoxin, that requires P- glycoprotein for absorption and elimination - 4

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

  1. Toxic levels of warfarin building up
  2. Decreased response to warfarin
  3. Increased risk for significant drug interactions with warfarin
  4. Less risk of drug interactions with warfarin - 2

Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.

  1. True
  2. False - 2

Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

  1. Erythromycin
  2. Digoxin
  3. Cetuximab
  4. Rifampin - 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:

  1. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele
  2. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele
  1. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B* allele
  2. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine - 3

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

  1. Decreased effectiveness of irinotecan in the treatment of cancer
  2. Increased adverse drug reactions, such as neutropenia
  3. Delayed metabolism of the prodrug irinotecan into the active metabolite SN-
  4. Increased concerns for irinotecan being carcinogenic - 2

Patients who have a poor metabolism phenotype will have:

  1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
  2. Accumulation of inactive metabolites of drugs
  3. A need for increased dosages of medications
  4. Increased elimination of an active drug - 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, nonmetabolized drug
  4. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug - 2

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

  1. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
  1. Identify potential drug-drug interactions that may occur with tamoxifen
  2. Reduce the likelihood of therapeutic failure with tamoxifen treatment
  3. Identify poor metabolizers of tamoxifen - 3

A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.

  1. 10
  2. 5
  3. 38
  4. 70 - 3

A potential harmful effect on patients who take some herbal medication is:

  1. Constipation
  2. Lead poisoning
  3. Diarrhea
  4. Life-threatening rash - 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. 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 - 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:

  1. Herbs which are yang in nature
  2. Herbs that are yin in nature
  1. Ginger
  2. Golden seal - 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:

  1. Get worse
  2. Get better
  3. Not be adequately treated
  4. Need additional herbs to treat the yan - 1

In Ayurvedic medicine, treatment is based on the patient's dominant dosha, which is referred to as the person's:

  1. Vata
  2. Pitta
  3. Kapha
  4. Prakriti - 4

Herbs and supplements are regulated by the U.S. Food and Drug Administration.

  1. True
  2. False - 2

When melatonin is used to induce sleep, the recommendation is that the patient:

  1. Take 10 mg 30 minutes before bed nightly
  2. Take 1 to 5 mg 30 minutes before bed nightly
  3. Not take melatonin more than three nights a week
  4. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep - 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:

  1. Cardiac disturbances
  2. Central nervous system depression
  3. Respiratory depression
  4. Skin rashes - 1

The standard dosage of St John's wort for the treatment of mild depression is:

  1. 300 mg daily
  2. 100 mg three times a day
  3. 300 mg three times a day
  4. 600 mg three times a day - 3

Patients need to be instructed regarding the drug interactions with St John's wort, including:

  1. MAO inhibitors
  2. Serotonin reuptake inhibitors
  3. Over-the-counter cough and cold medications
  4. All of the above - 4

Ginseng, which is taken to assist with memory, may potentiate:

  1. Aricept
  2. Insulin
  3. Digoxin
  4. Propranolol - 2

Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:

  1. Antihypertensives, diuretics, and digoxin
  2. Antidiarrheals, antihistamines, and omeprazole
  1. Penicillin antibiotic class and benzodiazepines
  2. None of the above - 1

Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:

  1. Respiratory depression
  2. Cardiac disturbance
  3. Salicylates poisoning
  4. Life-threatening rashes - 3

The role of the NP in the use of herbal medication is to:

  1. Maintain competence in the prescribing of common herbal remedies
  2. Recommend common over-the-counter herbs to patients
  3. Educate patients and guide them to appropriate sources of care
  4. Encourage patients to not use herbal therapy due to the documented dangers - 3

Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:

  1. 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 - 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:

  1. The Food and Drug Administration MedWatch system
  2. TOXNET, the National Institutes of Health alert system
  3. The EHR clinical decision support system
  1. Lexicomp, a commercial medication alert system - 3

Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?

  1. Reduces time that prescribing drugs takes
  2. Eliminates the need to chart drugs prescribed
  3. Decreases prescribing and transcription errors
  4. Helps keep the number of drugs prescribed to a minimum - 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?

  1. Cost of initial setup
  2. Access to highly skilled experts
  3. Compatibility between systems
  4. Patient confidentiality risks - 2

EHRs:

  1. 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 - 2

Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:

  1. Designing software so that only those who need the information can gain access
  2. Requiring providers to log off at the end of the clinical day
  3. Keeping a file of the login and password information for each provider in a secure

place

  1. Having patients sign informed consent documents to have their data on an EHR - 1

Decision support systems often provide medication alerts that tell the prescriber:

  1. Patient history data with a summary of their diagnoses
  2. The usual dosage for the drug being prescribed
  3. The patient's latest laboratory values, such as potassium levels
  4. Potential drug-to-drug interactions with other medications the patient is taking - 4

Prescribers have been shown to override a medication alert about a patient's allergies when:

  1. The history showed that the patient had tolerated the medication in the past
  2. The benefit outweighed the risk
  3. The medication was therapeutically appropriate and needed
  4. All of the above - 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 - 2

The advantage of using information technology for patient education includes:

  1. The ability to track the number of times you have given the patient the same instructions regarding their medication
  2. Standardized and individualized patient education that is simultaneously recorded into the patient record
  3. Easy access to private patient information specific to populations with a similar diagnosis
  1. The ability to download and interpret patient information in multiple languages, easily and accurately - 2

One barrier to use of the Internet for both prescribing and for patient teaching is:

  1. Lack of free public access to the Internet
  2. Age, with older adults rarely understanding how to use a computer
  3. Web pages and hyperlinks may change, be deleted, or be replaced
  4. Few Web sites with information about drugs are free - 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:

  1. Prioritize what is needed information and avoid spending time reading "interesting" information not central to the problem at hand
  2. Integrate professional and personal searching so that the same browser does not need to be accessed repeatedly
  3. Check e-mail frequently so that patient questions can be addressed promptly
  4. Check for viruses, spyware, and malware - 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:

  1. The patient's current diagnosis and history
  2. Drugs the patient is currently taking
  3. Any recent previous encounter for the same problem as this visit and what was done
  4. All of the above - 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?

  1. Patients feel the provider does not care about them if they are not seen in a face-to- face encounter.
  2. Data collected from patients between encounters via IT is less accurate and complete.
  1. Collecting data between encounters via IT may mean a more efficient face-to-face encounter.
  2. Between encounters is a good time to collect screening data. - 3

Discharge summaries using information technology have several advantages. They can:

  1. Replace the need for oral instruction because the patient has printed material to read at home
  2. Be filed with the patient's chart to document patient teaching
  3. Both 1 and 2
  4. Neither 1 nor 2 - 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:

  1. Warning them about the questionable quality of health information online
  2. 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 - 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:

  1. Turning the screen around so the patient can see material being recorded
  2. Not placing the computer screen between the provider and the patient
  3. Both 1 and 2
  4. Neither 1 nor 2 - 3

Pharmacoeconomics is:

  1. The study of the part of the U.S. economy devoted to drug use
  1. The study of the impact of prescription drug costs on the overall economy
  2. The analysis of the costs and consequences of any health-care-related treatment or service
  3. The analysis of the clinical efficacy of the drug - 3

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:

  1. Loss of wages while undergoing therapy
  2. Inconvenience, pain, and suffering incurred with therapy
  3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels
  4. Cost of prescription drug coverage, such as Medicare Part D - 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:

  1. Cost-minimization analysis
  2. Cost-of-illness analysis
  3. Cost-effectiveness analysis
  1. Cost-benefit analysis - 1

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
  4. Expressed in terms of patient preference or quality-adjusted life years - 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:

  1. Cost-minimization analysis
  2. Cost-of-illness analysis
  3. Cost-effectiveness analysis
  4. Cost-benefit analysis - 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. - 3

Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists:

  1. Increases the complexity of the pharmacoeconomics of prescribing for the individual patient
  2. Increases compliance by reducing the financial burden of drug costs to the patient
  3. Is not sound prescribing practice due to the inferiority of the generic products
  4. Will increase the overall cost of drugs to the system due to the ease of overprescribing less-expensive drugs - 2

James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:

  1. Order cognitive testing to determine the source of his confusion.
  2. Sit down with him and explain the whole Medicare Part D process.
  3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him.
  4. Request his son come to the next appointment so you can explain the benefit to him.
  • 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 - 3

Research has shown that when patients who are covered by Medicare Part D reach the "donut hole" in coverage they:

  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 warfarin or a statin
  3. Fill their critical medications, but hold off on filling less-critical medications
  4. Demonstrate no change in their prescription filling pattern - 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:

  1. Be safe and labeled for appropriate use
  2. Have a low potential for abuse or misuse
  1. Be taken for a condition the patient can reliably self-diagnose
  2. All of the above - 4

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 - 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:

  1. Get a new patent for the over-the-counter form of the drug
  2. Lower the costs because most prescription benefit plans do not cover generics
  3. 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 - 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.

  1. True
  2. False - 1

The ailment that generates the greatest over-the-counter annual drug sales is:

  1. Constipation
  2. Cough and colds
  3. Heartburn
  4. Acute and chronic pain - 2

Common over-the-counter pain relievers such as acetaminophen or ibuprofen:

  1. Are always safer for the patient than prescription pain medication
  2. Are harmful if taken in higher than recommended amounts
  3. Have minimal interaction with prescription medications
  4. Should never be given to children unless recommended by their provider - 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:

  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 are not an important part of his drug history
  4. A common misuse of over-the-counter aspirin - 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 - 4

When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:

  1. Not to take their regularly prescribed medications while on these antibiotics
  2. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption
  3. Not to take antacids while on these medications, as the antacid decreases absorption
  4. That there are no drug interactions with these antibiotics - 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?

  1. High-dose colchicine
  2. Low-dose colchicine
  3. High-dose aspirin
  4. Acetaminophen with codeine - 2

Patient education when prescribing colchicine includes:

  1. Colchicine may be constipating.
  2. Colchicine always causes some degree of diarrhea.
  3. Mild muscle weakness is normal.
  4. Moderate amounts of alcohol are safe with colchicine. - 2

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:

  1. Complete blood count
  2. Blood glucose
  3. C-reactive protein
  4. BUN, creatinine, and creatinine clearance - 4

Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:

  1. Gout may worsen with therapy.
  2. Febuxostat may cause severe diarrhea.
  3. He should consume a high-calcium diet.
  4. He will need frequent CBC monitoring. - 1

Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:

  1. Gout
  2. Iron deficiency anemia
  1. Osteoporosis
  2. Renal dysfunction - 3

Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:

  1. Metformin, a biguanide to prevent diabetes
  2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
  3. Naproxen, an NSAID to treat joint pain
  4. Furosemide, a diuretic to treat fluid retention - 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?

  1. Patients with asthma are transitioned directly off the prednisone onto inhaled

corticosteroids.

  1. Prednisone can be abruptly discontinued with no adverse effects.
  2. Develop a tapering schedule to slowly wean Daniel off the prednisone.
  3. Substitute the prednisone with another anti-inflammatory such as ibuprofen - 3

Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co- treatment with which medications to prevent further adverse effects?

  1. A bisphosphonate
  2. Calcium supplementation
  3. Vitamin D
  4. All of the above - 4

Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:

  1. Serum glucose
  2. Stool culture