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

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Pharmacotherapeutics for Advanced Practice Nurse

Prescribers.

Nurse practitioner prescriptive authority is regulated by who? - Correct Answer The State Board of Nursing for Each State What is the benefits of having an APRN prescriber? - Correct Answer APRN's care for patients more holistically and include patients in making decisions regarding their care What does clinical judgement in prescribing include? - Correct Answer Factoring in the cost of the particular What is included in the criteria for choosing and effective drug for a disorder? - Correct Answer Consulting nationally recognized guidelines for disease management NP's thrive under the new health-care reform because of what? - Correct Answer 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 Answer The Distribution of drugs to target tissues may be affected Drugs that have an significant first-pass effect what? - Correct Answer 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 Answer Lungs Medroxyprogesterone (Depo Provera) is prescribed IM to create storage reservoir of the drug. What are storage reserviors> - Correct Answer 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 Answer 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 Answer Rapidly actives drug levels in the therapeutic range

The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - Correct Answer Onset of action Phenytoin required that a trough level be drawn. When and why are peak and trough levels are done - Correct Answer To determine if a d rug is in the therapeutic range Drugs that are receptor agonists may demonstrate what property? - Correct Answer Concentrations will produce an adverse effect Factors that affect gastric drug absorption include - Correct Answer Lipid solubility of the drug Drugs that are receptors antagonists, such as beta-blockers, may cause what? - Correct Answer An exaggerated response if abrupt discontinues Drug administration via IV:

1. need to be lipid soluble in order to absorb easily
2. Begin distribution in the body immediately
3. Are easily absorbed if they are nonionized
4. May use pinocytosis to be absorbed - Correct Answer Are easily absorbed if they are nonionized What is the combination effect when a medication is added to a regimen for a synergistic effect? - Correct Answer Greater than the sum of the effects of each drug individually Which of the following statements about bioavailability is true?
5. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.
6. brands of a drug have the same bioavailability.
7. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
8. Combining an active drug with an inert substance does not affect bioavailability. - Correct Answer Bioavailability issues are especially important for drugs with narrow therapeutic

What reduces the inhibition properties of Phase 1 Oxidative reductive process of drug metabolism? - Correct Answer What is the period of time called that it takes for a drug too decreased by 50% in the body? - Correct Answer 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 Answer Is modified by the concurrent administration of another drug What happens when a drug antagonist is given regularly? - Correct Answer Down regulated the number of specific receptors What should be included in the education fo those who are prescribed oral enteric coated tables - Correct Answer 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 Answer 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 Answer 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.
6. A rich blood supply to the area of absorption leads to better absorption.
7. The less soluble the drug, the more easily it is absorbed.

4. Ionized drugs are easily absorbed across the cell membrane. - Correct Answer A rich blood supply of the are of absorption leads to better absorption What is an advantage of prescribing a sublingual medication? - Correct Answer Absorbed rapidly Drugs that use CYP 3A4 isoenzymes for metabolism may? - Correct Answer Induced and inhibit the metabolism of another drug When do drugs reach steady state? - Correct Answer After four or give half lives Ppregulation or hyper sensitization may lead to - Correct Answer An exaggerated response if the drug is withdrawn Why do prescribers often use liquid medications such as liquid ibuprofen for children? - Correct Answer Children often able to swallow pills In deciding which of multiple drugs used to treat a condition, the NPO chooses Drug A because it:
5. Has serious side effects and it is being used for a life-threatening condition
6. Will be taken twice daily and will be taken at home
7. Is expensive, but covered by health insurance
8. Non of these are important in choosing a drug - Correct Answer Will be taken twice daily and will be taken at home What is known about the differences between the pharmacokinetics of men and women. - Correct Answer Percentage of fat differs between genders What is the first step of the prescribing process according to WHO? - Correct Answer Diagnosis the problem Treatment goals in prescribing should: - Correct Answer be patient-centered The therapeutic goals when prescribing include - Correct Answer curative, palliative, and preventative

What does the US Drug Enforcement Administration Regulate? - Correct Answer Registers manufacturers and prescribers of controlled substances Are drugs that are disgnedated Schedule II by the DEA refillable - Correct Answer No. A new prescription needs to be written What are some precautions when prescribing a controlled substance? - Correct Answer 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 Answer 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 Answer Stealing and borrowing another patients drugs When are medications agreements/pain medication contracts recommended? - Correct Answer Universally for all medications prescribed for chronic pain When and what do prescriptions needs to be written - Correct Answer 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
3. 3 month old female 4)48 year old male - Correct Answer 3 month old Why are infants and babies are a higher risk of adverse drug reactions? - Correct Answer lack of safety and efficacy studies in pediatric populations Why are elderly at high risk of adverse drug reactions? - Correct Answer Age-related decrease in renal function

The type of adverse drug reaction that is idiosyncratic when a drug is given in the usual therapeutic dose is type - Correct Answer Type B Digoxin may cause a type A adverse drug reaction due to:

1. Idiosyncratic effects
2. Its narrow therapeutic index
3. Being a teratogen
4. Being a carcinogen - Correct Answer Its narrow therapeutic index What type of reaction occurs after a medication is used? - Correct Answer Type IV If neutropenia occurs after the use of a topical medication, what type of reaction is neutropenia characterized as - Correct Answer Cytotoxic hypersensitivyt reaction What type of reaction is anaphylactic shock? - Correct Answer Type 1 Reaction; Also known as an immediate hypersensitivity reaction What time of reaction is someone using a corticosteroid at risk for? - Correct Answer Type C Why do immunomodulators such as azathioprine cause a delayed reaction (type D reaction) - Correct Answer because they are carcinogens An example of a first-dose reaction that may occur includes:
5. Orthostatic hypotension that does not occur with repeated doses
6. Purple glove syndrome with phenytoin use
7. Hemolytic anemia from ceftriaxone use
8. Contact dermatitis from neomycin use - Correct Answer Orthostatic hypotension that does not occur with repeated doses Drugs that are prone to cause adverse drug reactions include - Correct Answer Insulins US FDA MedWatch system is activated when: - Correct Answer An adverse even or serious problem occurs with a medication that is not already identified on the label

2. Diphenhydramine
3. Ipratropium
4. Albuterol - Correct Answer Albuterol Patients with pheochromocytoma should avoid what class of drug and why? - Correct Answer Beta- 2 - Agonists as it causes hypertensive crisis What medications should be use cautiously with African American men with moderate persistent asthma? - Correct Answer 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 Answer increased risk of asthma related deaths What is the bronchodilator of choice for those taking propranolol? - Correct Answer Ipratropium Life-style management for those taking theophylline. - Correct Answer self-monitoring of respiratory status w. peak flowmeter; stop smoking; voice environmental triggers for asthma What does Tiotropium bromide treat (Spiriva)? - Correct Answer COPD the medication is an inhaled anticholinergic How often should Beclomethasone be used for someone with asthma? - Correct Answer Daily What are some side effects if montelukast (singular)? - Correct Answer Aggression, anxiety, depression, and or suicidal thoughts Who can montelukast be prescribed for? - Correct Answer a child with moderate persistent asthma Are there known drug reactions with Beclomethasone (QVAR) - Correct Answer No What prescription of the following will someone with acute rhinitis benefit from?

1. Fluticasone
2. Cetirizine (Zyrtec)
3. OTC Cromolyn Nasap Spray (Nasalcrom)
4. Any of the Above? - Correct Answer Any of the above What should be monitor for those who are taking diphenhydramine? - Correct Answer Urinary retention Why are second generation antihistamines such as Claritin taking for seasonal allergies instead of first generation? - Correct Answer They are less sedating then first generation antihistamines Who can be prescribed Sudafed? - Correct Answer Anyone over the age of 4 years old In what populations should cough and cold medicines that contain sympathomimetic decongestion be used cautiously? - Correct Answer Older adults, infects, and hypertensive patients What is the first line decongestant for someone who is hypertensive? - Correct Answer Nasal Oxymetazoline What is the first line treatment for a 5 year old with a URI? - Correct Answer Fluids and symptomatic care What is an effective, cost effective treatment for impetigo form an insect bite? - Correct Answer Bacitracin and Ploymixin B What are the instructions for applying a topical antibiotic or antiviral ointment? - Correct Answer Was hands before and after the application of topical antimicrobials