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Pharmacotherapeutics for Advanced Practice
Nurse Prescribers QUESTIONS AND
ANSWERS
Drugs that use CYP 3A4 isoenzymes for metabolism may:
- Induce the metabolism of another drug
- Inhibit the metabolism of another drug
- Both 1 and 2
- Neither 1 nor 2 - ANSWER>>
Medication agreements or "Pain Medication Contracts" are recommended to be used:
- Universally for all prescribing for chronic pain
- For patients who have repeated requests for pain medication
- When you suspect a patient is exhibiting drug-seeking behavior
- For patients with pain associated with malignancy - ANSWER>>
Drugs that are prone to cause adverse drug effects include:
- Diuretics
- Inhaled anticholinergics
- Insulins
- Stimulants - ANSWER>>
The U.S. Food and Drug Administration MedWatch system is activated when:
- There is an adverse event to a vaccine.
- The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication label.
- A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
- An adverse event or serious problem occurs with a medication that is not already identified on the label. - ANSWER>>
The Vaccine Adverse Events Reporting System is:
- A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event
- A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events
- Utilized to send out safety alerts regarding emerging vaccine safety issues
- Activated when a vaccine has been proven to cause significant adverse effects - ANSWER>>
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?
- Financial status
- Mobility
- Social support
- Sexual practices - ANSWER>>
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?
- Use correct medical terminology because Spanish has a Latin base.
- Use a family member who speaks more English to act as an interpreter.
- Use a professional interpreter or a reliable staff member who can act as an interpreter.
- Use careful, detailed explanations. - ANSWER>>
Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?
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:
- Has a short half-life so that missing one dose has limited effect
- Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
- Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
- Must be taken no more than twice a day - ANSWER>>
Factors in chronic conditions that contribute to nonadherence include:
- The complexity of the treatment regimen
- The length of time over which it must be taken
- Breaks in the usual daily routine, such as vacations and weekends
- All of the above - ANSWER>>
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:
- The provider spent a lot of time discussing the drugs with them
- Their concerns and specific area of knowledge deficit were addressed
- They were given written material, such as pamphlets, about the drugs
- The provider used appropriate medical and pharmacological terms - ANSWER>>
Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:
- With a longer half-life so that missed doses produce a longer taper on the drug curve
- In oral formulations that are more easily taken
- That do not require frequent monitoring
- Combined with patient education about the need to adhere even when symptoms are absent
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?
- Have the patient purchase a pill container with compartments for daily or multiple times-per- day dosing.
- Match the clinic appointment to the next time the drug is to be refilled.
- Write prescriptions for new drugs with shorter times between refills.
- Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. - ANSWER>>
Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
- Older adults and those on fixed incomes
- Patients with chronic illnesses
- Patients with copayments for drugs on their insurance
- Patients on public assistance - ANSWER>>
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:
- Are well-educated and affluent
- Have chronic conditions
- Self-monitor drug effects on their symptoms
- None of the above guarantee adherence - ANSWER>>
Monitoring adherence can take several forms, including:
- Patient reports from data in a drug diary
- Clinics that serve ethnic minorities - ANSWER>>
According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:
- May be a bilingual family member
- May be a bilingual nurse or other health-care provider
- Must be a professionally trained medical interpreter
- Must be an employee of the organization - ANSWER>>
According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
- The belief among African Americans that prayer is more powerful than drugs
- Poor compliance on the part of the African American patient
- The genetic predisposition for illness found among African Americans
- Discrimination, cultural barriers, and lack of access to health care - ANSWER>>
The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
- Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
- Largely unknown due to lack of studies of this population
- Rapid metabolism of alcohol, leading to increased tolerance
- Decreased elimination of opioids, leading to increased risk for addiction - ANSWER>>
Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
- True
- False - ANSWER>>
Alterations in drug metabolism among Asians may lead to:
- Slower metabolism of antidepressants, requiring lower doses
- Faster metabolism of neuroleptics, requiring higher doses
- Altered metabolism of omeprazole, requiring higher doses
- Slower metabolism of alcohol, requiring higher doses - ANSWER>>
Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
- Require acetylization in order to metabolize drugs
- Are unable to tolerate higher doses of some drugs that require acetylization
- May have a toxic reaction to drugs that require acetylization
- Require higher doses of drugs metabolized by acetylization to achieve efficacy - ANSWER>>
Hispanic native healers (curanderas):
- Are not heavily utilized by Hispanics who immigrate to the United States
- Use herbs and teas in their treatment of illness
- Provide unsafe advice to Hispanics and should not be trusted
- Need to be licensed in their home country in order to practice in the United States - ANSWER>>
Genetic polymorphisms account for differences in metabolism, including:
- Poor metabolizers, who lack a working enzyme
- Intermediate metabolizers, who have one working, wild-type allele and one mutant allele
- Extensive metabolizers, with two normally functioning alleles
- All of the above - ANSWER>>
Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
- A need to monitor drugs metabolized by 2D6 for toxicity
- Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
- Erythromycin
- Digoxin
- Cetuximab
- Rifampin - ANSWER>>
Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:
- Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA- B*1502 allele
- Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele
- Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele
- Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine - ANSWER>>
A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:
- Decreased effectiveness of irinotecan in the treatment of cancer
- Increased adverse drug reactions, such as neutropenia
- Delayed metabolism of the prodrug irinotecan into the active metabolite SN-
- Increased concerns for irinotecan being carcinogenic - ANSWER>>
Patients who have a poor metabolism phenotype will have:
- Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
- Accumulation of inactive metabolites of drugs
- A need for increased dosages of medications
- Increased elimination of an active drug - ANSWER>>
Ultra-rapid metabolizers of drugs may have:
- To have dosages of drugs adjusted downward to prevent drug accumulation
- Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
- Increased elimination of active, nonmetabolized drug
- Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug - ANSWER>>
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
- Ensure the patient will not have increased adverse drug reactions to the tamoxifen
- Identify potential drug-drug interactions that may occur with tamoxifen
- Reduce the likelihood of therapeutic failure with tamoxifen treatment
- Identify poor metabolizers of tamoxifen - ANSWER>>
A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.
- 10
- 5
- 38
- 70 - ANSWER>>
A potential harmful effect on patients who take some herbal medication is:
- Constipation
- Lead poisoning
- Diarrhea
- Life-threatening rash - ANSWER>>
- Prakriti - ANSWER>>
Herbs and supplements are regulated by the U.S. Food and Drug Administration.
- True
- False - ANSWER>>
When melatonin is used to induce sleep, the recommendation is that the patient:
- Take 10 mg 30 minutes before bed nightly
- Take 1 to 5 mg 30 minutes before bed nightly
- Not take melatonin more than three nights a week
- Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep - ANSWER>>
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:
- Cardiac disturbances
- Central nervous system depression
- Respiratory depression
- Skin rashes - ANSWER>>
The standard dosage of St John's wort for the treatment of mild depression is:
- 300 mg daily
- 100 mg three times a day
- 300 mg three times a day
- 600 mg three times a day - ANSWER>>
Patients need to be instructed regarding the drug interactions with St John's wort, including:
- MAO inhibitors
- Serotonin reuptake inhibitors
- Over-the-counter cough and cold medications
- All of the above - ANSWER>>
Ginseng, which is taken to assist with memory, may potentiate:
- Aricept
- Insulin
- Digoxin
- Propranolol - ANSWER>>
Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
- Antihypertensives, diuretics, and digoxin
- Antidiarrheals, antihistamines, and omeprazole
- Penicillin antibiotic class and benzodiazepines
- None of the above - ANSWER>>
Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
- Respiratory depression
- Cardiac disturbance
- Salicylates poisoning
- Life-threatening rashes - ANSWER>>
The role of the NP in the use of herbal medication is to:
- Maintain competence in the prescribing of common herbal remedies
- Recommend common over-the-counter herbs to patients
- Educate patients and guide them to appropriate sources of care
- Compatibility between systems
- Patient confidentiality risks - ANSWER>>
EHRs:
- Are being discouraged by the Centers for Medicare and Medicaid Services due to cost issues
- Allow for all patient data to be centralized in one location for access by multiple providers
- Use macros and templates to individualize care
- Use standardized software to facilitate interoperability between systems - ANSWER>>
Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:
- Designing software so that only those who need the information can gain access
- Requiring providers to log off at the end of the clinical day
- Keeping a file of the login and password information for each provider in a secure
place
- Having patients sign informed consent documents to have their data on an EHR - ANSWER>>
Decision support systems often provide medication alerts that tell the prescriber:
- Patient history data with a summary of their diagnoses
- The usual dosage for the drug being prescribed
- The patient's latest laboratory values, such as potassium levels
- Potential drug-to-drug interactions with other medications the patient is taking - ANSWER>>
Prescribers have been shown to override a medication alert about a patient's allergies when:
- The history showed that the patient had tolerated the medication in the past
- The benefit outweighed the risk
- The medication was therapeutically appropriate and needed
- All of the above - ANSWER>>
The use of information technology for quality improvement in pharmacotherapeutics includes:
- Incorporating the use of "apps" into all patient encounters
- Tracking data trends within the practice via the electronic health record database
- Informing patients that they have access to their medication list via the Internet
- Using macros for individualizing patient care management - ANSWER>>
The advantage of using information technology for patient education includes:
- The ability to track the number of times you have given the patient the same instructions regarding their medication
- Standardized and individualized patient education that is simultaneously recorded into the patient record
- Easy access to private patient information specific to populations with a similar diagnosis
- The ability to download and interpret patient information in multiple languages, easily and accurately - ANSWER>>
One barrier to use of the Internet for both prescribing and for patient teaching is:
- Lack of free public access to the Internet
- Age, with older adults rarely understanding how to use a computer
- Web pages and hyperlinks may change, be deleted, or be replaced
- Few Web sites with information about drugs are free - ANSWER>>
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:
- Prioritize what is needed information and avoid spending time reading "interesting" information not central to the problem at hand
- Warning them about the questionable quality of health information online
- Identifying easily used "apps" that patients can use to manage their medications
- Teaching them how to identify high-quality Web sites and "red flags" signaling inaccurate content
- All of the above - ANSWER>>
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:
- Turning the screen around so the patient can see material being recorded
- Not placing the computer screen between the provider and the patient
- Both 1 and 2
- Neither 1 nor 2 - ANSWER>>
Pharmacoeconomics is:
- The study of the part of the U.S. economy devoted to drug use
- The study of the impact of prescription drug costs on the overall economy
- The analysis of the costs and consequences of any health-care-related treatment or service
- The analysis of the clinical efficacy of the drug - ANSWER>>
The direct costs of drug therapy include:
- The actual cost of acquiring the medication
- The loss of income due to illness
- Pain and suffering due to inadequate drug therapy
- The cost of a funeral associated with premature death - ANSWER>>
Indirect costs associated with drug therapy include:
- The cost of diagnostic tests to monitor therapeutic levels
- Health-care provider time to prescribe and educate the patient
- Child-care expenses incurred while receiving therapy
- Loss of wages while undergoing drug therapy - ANSWER>>
The intangible costs of drug therapy include:
- Loss of wages while undergoing therapy
- Inconvenience, pain, and suffering incurred with therapy
- Cost of medical equipment in the laboratory used to monitor therapeutic drug levels
- Cost of prescription drug coverage, such as Medicare Part D - ANSWER>>
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:
- Cost-minimization analysis
- Cost-of-illness analysis
- Cost-effectiveness analysis
- Cost-benefit analysis - ANSWER>>
Cost-effectiveness analysis compares two or more treatments or programs that are:
- Not necessarily therapeutically equivalent
- Considered equal in efficacy
- Compared with the dollar value of the benefit received
- Expressed in terms of patient preference or quality-adjusted life years - ANSWER>>
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:
- Cost-minimization analysis
