Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Questions and Answers, Exams of Nursing

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PHARMACOTHERAPEUTICS FOR

ADVANCED PRACTICE NURSE

PRESCRIBERS QUESTION AND

ANSWERS

Nurse practitioner prescriptive authority is regulated by who? - Correct Answers: The State Board of Nursing for Each State What is the benefits of having an APRN prescriber? - Correct Answers: APRN's care for patients more holistically and include patients in making decisions regarding their care What does clinical judgement in prescribing include? - Correct Answers: Factoring in the cost of the particular What is included in the criteria for choosing and effective drug for a disorder? - Correct Answers: Consulting nationally recognized guidelines for disease management NP's thrive under the new health-care reform because of what? - Correct Answers: NP's have the ability to control care cost and improve patient outcome Nutritional intake and lab results reflect hypoalbuminemia; why is this important for prescribers? - Correct Answers: The Distribution of drugs to target tissues may be affected Drugs that have an significant first-pass effect what? - Correct Answers: they are rapidly metabolized by the liver and may have little if any desired action The route of excretion of a volatile drug will likely be? - Correct Answers: Lungs Medroxyprogesterone (Depo Provera) is prescribed IM to create storage reservoir of the drug. What are storage reserviors> - Correct Answers: Increased the length of time a drug is available and active Why is Cephalexin given every 8 hours? What knowledge of the drug does the NP know? - Correct Answers: Half Life Azithromycin doing requires that the first day's doing be twice those of the other four day; This is considered a loading does. What is a loading dose? - Correct Answers: Rapidly actives drug levels in the therapeutic range

Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

1. Water soluble and ionized drugs cross these barriers rapidly.
2. The blood-brain barrier slows the entry of many drugs into and from brain cells.
3. The fetal-placental barrier protects the fetus from drugs taken by the mother.
4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women - Correct Answers: The blood-brain barrier slows the entry of many drugs into and from brain cells. What is the purpose of phase I and phase II of metabolism in the liver? - Correct Answers: Change drug molecules to a form that an excretory organ can excrete What happens to the metabolites after they are metabolized in the liver? - Correct Answers: the metabolite may or may not be more active than the parent drug and they are totally deactivated so they are excreted without and effect; it depends on the medication being given What causes the body to increased the excretion of a drug through the renal system - Correct Answers: Unbinding a nonvolatile drug from plasma proteins. What is "steady state"? - Correct Answers: When the amount of the drug in the body remains constant When two pain medications are given together to treat pain, what kind of drug-to-drug interaction occurs? - Correct Answers: Additive Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
5. Reducing the dosage of one of the drugs
6. Scheduling their administration at different times
7. Prescribing a third drug to counteract the adverse reaction of the combination
8. Reducing the dosage of both drugs - Correct Answers: Prescribing a third drug to counteract the adverse reaction of the combination

What reduces the inhibition properties of Phase 1 Oxidative reductive process of drug metabolism? - Correct Answers: What is the period of time called that it takes for a drug too decreased by 50% in the body? - Correct Answers: Half Life Drug antagonism is best defined as an effect of a drug that:

1. Leads to major physiological and psychological dependence
2. Is modified by the concurrent administration of another drug
3. Cannot be metabolized before another dose is administered
4. Leads to a decreased physiological response when combined with another drug - Correct Answers: Is modified by the concurrent administration of another drug What happens when a drug antagonist is given regularly? - Correct Answers: Down regulated the number of specific receptors What should be included in the education fo those who are prescribed oral enteric coated tables - Correct Answers: To achieve best effect, take the tablet with at least 8 oz of fluids What is the main reason for not crushing a sustained-released. capsule? - Correct Answers: It can cause toxicity What medication in the follow is mostly absorbed in the intestines rather than the stomach?

1. Sodium bicarb
2. ascorbic acid
3. salicylic acid
4. glucose - Correct Answers: Sodium Bicarb Which of the following variables is a factor in drug absorption?
5. The smaller the surface area for absorption, the more rapidly the drug is absorbed.

Treatment goals in prescribing should: - Correct Answers: be patient-centered The therapeutic goals when prescribing include - Correct Answers: curative, palliative, and preventative When determining drug treatment, what should an NP always do? - Correct Answers: Individualize the drug choice for the specific patient What should patient education include when prescribing a medication? - Correct Answers: Discussion on adverse effects of the medication Passive monitoring of drug effectiveness includes:

1. Therapeutic drug levels
2. Adding or subtracting medications from the treatment regimen
3. Ongoing provider visits
4. Instructing the patient to report if the drug is not effective - Correct Answers: Instructing the patient to report if the drug is not effective Pharmacokinetic factors that affect prescribing include - Correct Answers: Bioavailability What recommendations bu the Institute of Medicine were made to address the impact of pharmaceutical promotion - Correct Answers: Conflicts of interest and financial relationships should be disclosed by those providing education Under new U.S. FDA labeling, Pregnancy Categories will be: - Correct Answers: Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label What does the US FDA Regulate? - Correct Answers: The official labeling of all prescriptions and over the counter drugs What is approval of the FDA required for? - Correct Answers: Medical devices, including artificial joints

When is an investigational new drug filed with the FDA? - Correct Answers: Prior to human testing of any new drug entity Phase IV clinical trials in the US are also known as - Correct Answers: Postmarketing research trials Is off-label prescribing legal? - Correct Answers: yes if there is scientific evidence for the use What does the US Drug Enforcement Administration Regulate? - Correct Answers: Registers manufacturers and prescribers of controlled substances Are drugs that are disgnedated Schedule II by the DEA refillable - Correct Answers: No. A new prescription needs to be written What are some precautions when prescribing a controlled substance? - Correct Answers: Using tamper- proof paper for all prescriptions written for controlled drugs. What are some strategies for prescribers to use to prevent the misuse of controlled prescriptions? - Correct Answers: Use a chemical dependency screening tool; fir limit-setting regarding controlled substances; and practicing saying no to deal with patients who are push overs What are some behaviors that predict addition to controlled substances - Correct Answers: Stealing and borrowing another patients drugs When are medications agreements/pain medication contracts recommended? - Correct Answers: Universally for all medications prescribed for chronic pain When and what do prescriptions needs to be written - Correct Answers: Medical devices, controlled drugs, and legend drugs Based on the patients below, who is at high risk for experiencing an adverse drug reaction?

1. 32-year old male
2. 22- year told female

An example of a first-dose reaction that may occur includes:

1. 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 - Correct Answers: Orthostatic hypotension that does not occur with repeated doses Drugs that are prone to cause adverse drug reactions include - Correct Answers: Insulins US FDA MedWatch system is activated when: - Correct Answers: An adverse even or serious problem occurs with a medication that is not already identified on the label The Vaccine Adverse Events Reporting System is - Correct Answers: A voluntary reporting system that healthcare providers or consumers may use to report vaccine adverse events What is pharmacoeconomics? - Correct Answers: The analysis of the cost and consequences of any health-care related treatment or services The direct cost of drug therapy includes - Correct Answers: Pain and suffering due to inadequate drug therapy Indirect costs associated with drug therapy include? - Correct Answers: Loss of wages while undergoing drug therapy The intangible cost of drug therapy include? - Correct Answers: Inconvenience, pain, and suffering incurred with therapy What is it called when a pharmacoeconomic analysis takes place regarding two similar treatments for a disease? - Correct Answers: Cost-minimization analysis Cost-effectiveness analysis compares two or more treatments or programs that are: - Correct Answers: not necessarily therapeutically equivalent

When the cost of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as - Correct Answers: Cost-benefit analysis What is a two-tiered prescription benefit plan? - Correct Answers: Higher co-pay for brand name drugs than for generic drugs When a provider proscribes a less expensive drug what does it increase and how? - Correct Answers: Compliance & by decreasing the financial burden set on the patient When someone asks to explain what a coverage plan means, such as a Medicare plan, what should the NP do? - Correct Answers: Refer the patient to a Medicare Specialist at his insurance carrier to explain the benefits of his insurance Digoxin levels need to be monitored closely when the following medication is started:

1. Loratadine
2. Diphenhydramine
3. Ipratropium
4. Albuterol - Correct Answers: Albuterol Patients with pheochromocytoma should avoid what class of drug and why? - Correct Answers: Beta-2- Agonists as it causes hypertensive crisis What medications should be use cautiously with African American men with moderate persistent asthma? - Correct Answers: Salmeterol - It is an inhaled long-acting beta agonist; studies showed increase of respiratory and asthma related deaths in African Americans LTBA's received a black box warning due to? - Correct Answers: increased risk of asthma related deaths What is the bronchodilator of choice for those taking propranolol? - Correct Answers: Ipratropium

In what populations should cough and cold medicines that contain sympathomimetic decongestion be used cautiously? - Correct Answers: Older adults, infects, and hypertensive patients What is the first line decongestant for someone who is hypertensive? - Correct Answers: Nasal Oxymetazoline What is the first line treatment for a 5 year old with a URI? - Correct Answers: Fluids and symptomatic care What is an effective, cost effective treatment for impetigo form an insect bite? - Correct Answers: Bacitracin and Ploymixin B What are the instructions for applying a topical antibiotic or antiviral ointment? - Correct Answers: Was hands before and after the application of topical antimicrobials